镁在维持性血液透析患者透析中低血压风险中的作用。

Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease, Shanghai, China.

Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.

Hemodial Int. 2020 Jul;24(3):351-358. doi: 10.1111/hdi.12833. Epub 2020 May 12.

INTRODUCTION

Intradialytic hypotension (IDH) is a common complication in end-stage renal disease patients on hemodialysis (HD). It has been documented that several factors contribute to IDH. However, the relationship between serum electrolytes and the occurrence of IDH remains unclear. Our study aims to investigate the role of serum magnesium (Mg) for the risk of IDH in maintenance HD patients.

METHODS

The retrospective study included adults starting HD before January 2009 in the blood purification center, Zhongshan Hospital, Fudan University, and treated thrice weekly with standard bicarbonate dialysate by low-flux HD. Patients' characteristics including age and sex, laboratory test results were collected. IDH was defined according to kidney disease outcomes quality initiative (K/DOQI) guidelines as a decrease in systolic blood pressure (SBP) by ≥20 mmHg or a decrease in mean arterial pressure (MAP) by ≥10 mmHg associated with clinical symptoms during HD. Multivariate logistic regression was employed to explore independent risk factors for IDH.

FINDINGS

Among 423 patients recruited, 175 patients (41.4%) suffered from IDH. Compared with those with non-IDH, patients with IDH presented higher predialysis serum Mg levels. Univariate correlation analysis showed that predialysis serum Mg level was negatively correlated with SBP at 3 hours, 4 hours after dialysis (3 hours SBP r = -0.134 P = 0.006, 4 hours SBP r = -0.142 P = 0.003) and was positively correlated with the differences of blood pressure (BP) (SBP and MAP) (△SBP r = 0.195 P < 0.001, △MAP r = 0.155, P = 0.001). After adjustment for predialysis blood urea nitrogen, platelet distribution width, cardiac troponin T, fasting blood glucose, β2-microglobulin, and predialysis MAP, multivariate logistic regression analysis demonstrated that predialysis serum Mg level was one of the independent risk factors for IDH (odds ratio [95% confidence interval-CI]: 7.154 (1.568-32.637); P = 0.011). In addition, Mg levels of 1.15 mmol/L or higher were associated with a high incidence of IDH.

DISCUSSION

Our findings suggested that higher predialysis serum Mg level was one of the independent risk factors for IDH among maintenance hemodialysis (MHD patients).

简介

透析中低血压（IDH）是接受血液透析（HD）的终末期肾病患者的常见并发症。已有文献证明，多种因素可导致 IDH。然而，血清电解质与 IDH 发生之间的关系尚不清楚。我们的研究旨在探讨血清镁（Mg）对维持性 HD 患者 IDH 风险的作用。

方法

这项回顾性研究纳入了 2009 年 1 月前在复旦大学中山医院血液净化中心开始接受 HD 治疗的成年人，每周 3 次接受标准碳酸氢盐透析液进行低通量 HD 治疗。收集患者的特征，包括年龄和性别、实验室检查结果。根据肾脏病预后质量倡议（K/DOQI）指南，将 IDH 定义为透析过程中收缩压（SBP）下降≥20mmHg 或平均动脉压（MAP）下降≥10mmHg 并伴有临床症状。采用多变量 logistic 回归分析探讨 IDH 的独立危险因素。

结果

在纳入的 423 名患者中，175 名（41.4%）患者发生 IDH。与非 IDH 患者相比，IDH 患者的透析前血清 Mg 水平较高。单变量相关分析显示，透析前血清 Mg 水平与透析后 3 小时、4 小时的 SBP 呈负相关（3 小时 SBP r = -0.134，P = 0.006；4 小时 SBP r = -0.142，P = 0.003），与血压（BP）差异呈正相关（SBP 和 MAP）（△SBP r = 0.195，P<0.001；△MAP r = 0.155，P = 0.001）。在校正透析前血尿素氮、血小板分布宽度、肌钙蛋白 T、空腹血糖、β2-微球蛋白和透析前 MAP 后，多变量 logistic 回归分析表明，透析前血清 Mg 水平是 IDH 的独立危险因素之一（比值比[95%置信区间-CI]：7.154（1.568-32.637）；P = 0.011）。此外，Mg 水平为 1.15mmol/L 或更高与 IDH 的高发生率相关。