Haemodialysis division, Dialysis Center, Nopparat Rajathanee Hospital, Bangkok, Thailand.
Center of Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Ren Care. 2021 Mar;47(1):34-42. doi: 10.1111/jorc.12340. Epub 2020 Jul 30.
Intradialytic hypotension (IDH) is one of the most critical adverse events during maintenance haemodialysis. Previous studies reported the association of fluid removal rate with the occurrence of IDH.
We aimed to identify the optimal threshold of ultrafiltration rate to prevent the occurrence of IDH events. DESIGN, PARTICIPANTS AND MEASUREMENTS: Prognostic factor research with a retrospective case-control design was conducted. Patient data were gathered from four haemodialysis units from January to December 2017. All the haemodialysis records were independently justified, whether IDH occurred or not, based on the standard definition. A total of 10 haemodialysis sessions were sampled from each patient's pool based on the incidence of events. The association of ultrafiltration rates and IDH events was explored by multivariable multilevel logistic regression.
A total of 1080 haemodialysis sessions from 108 patients were included: 149 (13.8%) with IDH and 931 (86.2%) without IDH. After adjusting for all pre-specified risk factors and imbalance baselines, the odds ratio of IDH were 1.22 (95% confidence interval [CI]: 0.59, 2.52) for rate 10-12 ml/kg/h; 2.52 (95% CI: 1.20, 5.29) for rate 12-14 ml/kg/h; 4.02 (95% CI: 1.61, 10.03) for rate 14-16 ml/kg/h; and 7.41 (95% CI: 2.53, 21.68) for rate >16 ml/kg/h comparing to the referent rate of <10 ml/kg/h.
The ultrafiltration rate should be limited to 12 ml/kg/h. If a higher rate of fluid removal was indicated, it should not exceed 16 ml/kg/h to avoid the occurrence of IDH.
透析中低血压（IDH）是维持性血液透析过程中最严重的不良事件之一。既往研究报告了超滤率与 IDH 发生之间的相关性。
旨在确定超滤率的最佳阈值，以预防 IDH 事件的发生。
设计、参与者和测量：采用回顾性病例对照研究设计进行预后因素研究。患者数据于 2017 年 1 月至 12 月从 4 个血液透析单位采集。所有血液透析记录均根据标准定义独立进行合理性验证，无论是否发生 IDH。根据事件发生率，从每位患者的记录中抽取 10 个血液透析记录。采用多变量多级逻辑回归探讨超滤率与 IDH 事件的相关性。
共纳入 108 例患者的 1080 个血液透析记录：149 个（13.8%）发生 IDH，931 个（86.2%）未发生 IDH。调整所有预先指定的危险因素和不平衡基线后，超滤率为 10-12ml/kg/h、12-14ml/kg/h、14-16ml/kg/h 和>16ml/kg/h 时 IDH 的比值比分别为 1.22（95%可信区间[CI]：0.59，2.52）、2.52（95%CI：1.20，5.29）、4.02（95%CI：1.61，10.03）和 7.41（95%CI：2.53，21.68），与<10ml/kg/h 的参考率相比。
超滤率应限制在 12ml/kg/h 以内。如果需要更高的液体清除率，不应超过 16ml/kg/h，以避免 IDH 的发生。
