Zhao Yuliang, Yang Letian, Yu Shaobin, Salerno Stephen, Li Yi, Cui Tianlei, Zhang Ling, Fu Ping
Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
Kidney Dis (Basel). 2021 Sep;7(5):411-424. doi: 10.1159/000511295. Epub 2020 Nov 10.
The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population.
Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included.
A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07-1.19; < 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10-1.22; < 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05-1.17; = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06-1.22; < 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause ( = 0.01) and cardiovascular ( = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01-1.17; = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52-1.42; = 0.56).
This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).
血压变异性（BPV）在接受血液透析患者中的预后价值尚无定论。在本研究中，我们旨在评估血液透析人群中BPV与临床结局之间的关联。
检索了PubMed/Medline、EMBASE、Ovid、Cochrane图书馆和Web of Science数据库中截至2020年4月1日发表的相关文章。纳入了关于BPV与接受血液透析患者预后之间关联的研究。
分析共纳入14项研究（37976例患者）。在接受血液透析的患者中，收缩压变异性与全因死亡率（风险比[HR]：1.13；95%置信区间[CI]：1.07 - 1.19；P < 0.001）和心血管死亡率（HR：1.16；95%CI：1.10 - 1.22；P < 0.001）升高相关。在收缩压变异性的分层分析中，发现透析间期收缩压变异性而非44小时动态收缩压变异性或透析中收缩压变异性与全因死亡率（HR：1.11；95%CI：1.05 - 1.17；P = 0.001）和心血管死亡率（HR：1.14；95%CI：1.06 - 1.22；P < 0.001）均相关。在不同的BPV指标中，收缩压变异系数是全因死亡率（P = 0.01）和心血管死亡率（P = 0.002）的预测指标。虽然舒张压变异性与接受血液透析患者的全因死亡率相关（HR：1.09；95%CI：1.01 - 1.17；P = 0.02），但它未能预测心血管死亡率（HR：0.86；95%CI：0.52 - 1.42；P = 0.56）。
这项荟萃分析表明，在接受血液透析的患者中，透析间期收缩压变异性与全因死亡率和心血管死亡率升高均相关。此外，收缩压变异系数被确定为在预测全因死亡率和心血管死亡率方面BPV的一个潜在有前景的指标。44小时动态收缩压变异性、透析中收缩压变异性以及舒张压变异性指标在血液透析人群预后中的应用需要进一步研究（PROSPERO注册号：CRD42019139215）。
