From the Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Yale New Haven Hospital, New Haven, Connecticut.
ASAIO J. 2022 Jun 1;68(6):865-873. doi: 10.1097/MAT.0000000000001576. Epub 2022 Sep 7.
Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of HD, especially following the longer interdialytic interval. We investigated the risk of IDH according to day of HD in adults undergoing in-center, thrice-weekly HD in the Hemodialysis (HEMO) Study (N = 1,837 patients; n = 64,474 sessions), and the DaVita Clinical Research biorepository [BioReG]) (N = 952 patients; n = 61,197 sessions). Random effects logistic regression models assessed the risk of IDH (defined as nadir intra-HD systolic blood pressure [SBP] <90 mm Hg if pre-HD SBP <160 mm Hg, or <100 mm Hg if pre-HD SBP ≥160 mm Hg [Nadir90/100 definition]) according to HD day (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]). Alternative definitions of IDH were explored. Nadir90/100 occurred in 14% of HEMO and 18% of BioReG sessions. A monotonic increase in the risk of IDH was observed for HD2 and HD3, compared with HD1, for all IDH definitions in both cohorts. Compared with HD1, HD2 was associated with a 10% higher risk of Nadir90/100 (adjusted odds ratio, 1.10; 95% CI, 1.03-1.17) and HD3 was associated with a 31% higher risk (adjusted odds ratio, 1.31; 95% CI, 1.19-1.45) in HEMO, with consistent results in BioReG. We observed a monotonic increased risk of IDH with later days of the dialytic week in two separate cohorts. Further research to determine the underlying mechanisms is necessary to guide strategies for IDH prevention.
透析中低血压（IDH）是血液透析（HD）的常见并发症，与心血管（CV）事件和死亡率的风险增加相关。CV 事件在 HD 日更为常见，尤其是在较长的透析间期后。我们在接受中心血液透析、每周三次的 HEMO 研究（N=1837 例患者；n=64474 次）和 DaVita 临床研究生物库（BioReG）（N=952 例患者；n=61197 次）的成人中，根据 HD 日研究了 IDH 的风险（定义为如果透析前 SBP＜160mmHg，则透析中收缩压（SBP）最低值＜90mmHg，如果透析前 SBP≥160mmHg，则最低值＜100mmHg[Nadir90/100 定义]）。采用随机效应逻辑回归模型评估 IDH 风险（定义为透析中收缩压（SBP）最低值＜90mmHg，如果透析前 SBP＜160mmHg，则最低值＜90mmHg[Nadir90/100 定义]）根据 HD 日（周一/周二[HD1]；周三/周四[HD2]；周五/周六[HD3]）。还探索了替代的 IDH 定义。HEMO 和 BioReG 中分别有 14%和 18%的次透析中出现 Nadir90/100。对于所有 IDH 定义，与 HD1 相比，HD2 和 HD3 观察到 IDH 的风险呈单调增加。与 HD1 相比，HD2 与 Nadir90/100 风险增加 10%相关（调整比值比，1.10；95%置信区间，1.03-1.17），HD3 与风险增加 31%相关（调整比值比，1.31；95%置信区间，1.19-1.45）在 HEMO 中，在 BioReG 中也有一致的结果。在两个独立的队列中，我们观察到透析周后期 IDH 的风险呈单调增加。需要进一步研究以确定潜在机制，为 IDH 预防提供指导。
