Research Division, Renal Research Institute, New York, New York, USA; Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Research Division, Renal Research Institute, New York, New York, USA.
Kidney Int. 2021 Jun;99(6):1408-1417. doi: 10.1016/j.kint.2021.01.018. Epub 2021 Feb 17.
Intradialytic hypotension (IDH) is a common complication of hemodialysis, but there is no data about the time of onset during treatment. Here we describe the incidence of IDH throughout hemodialysis and associations of time of hypotension with clinical parameters and survival by analyzing data from 21 dialysis clinics in the United States to include 785682 treatments from 4348 patients. IDH was defined as a systolic blood pressure of 90 mmHg or under while IDH incidence was calculated in 30-minute intervals throughout the hemodialysis session. Associations of time of IDH with clinical and treatment parameters were explored using logistic regression and with survival using Cox-regression. Sensitivity analysis considered further IDH definitions. IDH occurred in 12% of sessions at a median time interval of 120-149 minutes. There was no notable change in IDH incidence across hemodialysis intervals (range: 2.6-3.2 episodes per 100 session-intervals). Relative blood volume and ultrafiltration volume did not notably associate with IDH in the first 90 minutes but did thereafter. Associations between central venous but not arterial oxygen saturation and IDH were present throughout hemodialysis. Patients prone to IDH early as compared to late in a session had worse survival. Sensitivity analyses suggested IDH definition affects time of onset but other analyses were comparable. Thus, our study highlights the incidence of IDH during the early part of hemodialysis which, when compared to later episodes, associates with clinical parameters and mortality.
透析中低血压（IDH）是血液透析的常见并发症，但目前尚无关于其在治疗过程中何时发生的数据。在这里，我们通过分析美国 21 家透析诊所的数据，描述了整个血液透析过程中 IDH 的发生率，并通过分析数据来探讨低血压发生时间与临床参数和生存的相关性，这些数据包括来自 4348 名患者的 785682 次治疗。IDH 的定义为收缩压低于 90mmHg，IDH 的发生率在整个血液透析过程中以 30 分钟为间隔进行计算。使用逻辑回归分析探讨 IDH 发生时间与临床和治疗参数的相关性，使用 Cox 回归分析与生存的相关性。敏感性分析考虑了进一步的 IDH 定义。12%的透析治疗中发生了 IDH，其中位数发生时间间隔为 120-149 分钟。在血液透析间隔内，IDH 的发生率没有明显变化（范围：每 100 个治疗间隔出现 2.6-3.2 次 IDH）。在前 90 分钟内，相对血容量和超滤量与 IDH 没有明显关联，但之后则有关联。整个血液透析过程中，中心静脉血氧饱和度与 IDH 有关，而动脉血氧饱和度与 IDH 无关。与晚期相比，早期发生 IDH 的患者生存情况更差。敏感性分析表明，IDH 定义会影响其发生时间，但其他分析结果相似。因此，我们的研究强调了 IDH 在血液透析早期发生的情况，与后期发生的 IDH 相比，它与临床参数和死亡率有关。
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