Clin Nephrol. 2021 Sep;96(3):138-148. doi: 10.5414/CN110368.
Intra-dialytic hypotension episodes (ID-Hypos) cause significant reduction of dialysis efficiency and increased cardiovascular morbimortality. Atherosclerosis and vascular calcification are two closely inter-related processes that occur prematurely and progress aggressively in maintenance hemodialysis (MHD) patients.
To study the predictors of ID-Hypos, particularly a novel combined atherosclerosis-calcification score (CACS) (0 to 6) obtained by adding the atherosclerosis score (AS) to a modified abdominal aortic calcification score (AACS), each ranging 0 to 3.
In 60 adult MHD patients, AS was derived from ankle-brachial index and carotid ultrasound. AACS was modified from Kauppila score applied on lateral abdominal plain radiographs. The number of sessions complicated by ≥ 1 ID-Hypos over 14 weeks was recorded and correlated with CACS, ultrafiltration rate (UFR), and other hemodynamic and laboratory parameters.
Patients developed a median of 10.5 ID-Hypos (IQR 5.75 - 14). The number of ID-Hypos had a statistically significant positive correlation with CACS (r = 0.291, p = 0.024), but not with its individual components. AACS had a statistically significant positive correlation with s. phosphorus and calcium-phosphorus product. On multivariate analysis, the most significant independent predictors of ID-Hypos were high UFR, high CACS, and low hemoglobin. Serum C-reactive protein had a positive correlation with ID-Hypos that was lost in the adjusted models.
High UFR, CACS, and anemia are significant predictors of ID-Hypos. CACS may help in quantifying vascular pathology and characterizing MHD patients at highest risk for ID-Hypos, those who would be prioritized for potential preventive measures like biocompatible membranes or hemodiafiltration. A background of chronic inflammation may underlie and link patient-related ID-Hypos risk factors.
透析中低血压（ID-Hypos）发作会显著降低透析效率，并增加心血管发病率和死亡率。动脉粥样硬化和血管钙化是两个密切相关的过程，在维持性血液透析（MHD）患者中会过早且迅速进展。
研究 ID-Hypos 的预测因素，特别是一种新的动脉粥样硬化-钙化综合评分（CACS）（0 至 6），该评分通过将动脉粥样硬化评分（AS）添加到改良的腹主动脉钙化评分（AACS）中来获得，每个评分的范围均为 0 至 3。
在 60 名成年 MHD 患者中，AS 由踝臂指数和颈动脉超声得出。AACS 是从侧腹部平片上的 Kauppila 评分修改而来。记录 14 周内≥1 次 ID-Hypos 发作的透析次数，并将其与 CACS、超滤率（UFR）以及其他血流动力学和实验室参数相关联。
患者发生了中位数为 10.5 次 ID-Hypos（IQR 5.75-14）的发作。ID-Hypos 的发作次数与 CACS 呈显著正相关（r=0.291，p=0.024），但与 AS 无相关性。AACS 与 s.磷和钙磷乘积呈显著正相关。多变量分析显示，ID-Hypos 的最重要独立预测因素是高 UFR、高 CACS 和低血红蛋白。血清 C 反应蛋白与 ID-Hypos 呈正相关，但在调整后的模型中消失。
高 UFR、CACS 和贫血是 ID-Hypos 的重要预测因素。CACS 可能有助于量化血管病变，并对 ID-Hypos 风险最高的 MHD 患者进行特征描述，这些患者将被优先考虑采取潜在的预防措施，如使用生物相容性膜或血液透析滤过。慢性炎症背景可能是患者相关 ID-Hypos 危险因素的基础，并将其联系起来。
