Zhang Xuelei, Xu Ling, Zhou Peiyi, Song Dongqi, Wu Jian, Jia Lifang
Department of Nephrology, Daxing Teaching Hospital, Capital Medical University, Beijing, China.
Department of Urology, Daxing Teaching Hospital, Capital Medical University, Beijing, China.
Ther Apher Dial. 2022 Jun;26(3):624-631. doi: 10.1111/1744-9987.13745. Epub 2021 Oct 20.
Studies showed that pre-dialysis BP variability (BPV) was an independent risk factor of cardiovascular disease (CVD) among HD patients, but which is limited on how intradialytic BPV affects prognosis.
In this study, we designed a retrospective cohort study to examine the association between intradialytic BPV and CVD outcomes in HD patients. A total of 202 patients who underwent HD in our center were included, and all intradialytic BP measurements of November 2017 were obtained from the database. Patients were divided into four groups according to variability independent of the mean (VIM) interquartile.
The mean age was 62.1 ± 14.3 years, 60.9% were male, and median VIM was 14.75 (12.60-18.59). Multiple-regression analyses showed patients age, dialysis vintage, serum albumin, and the percentage of intradialytic weight gain as significant predictors of VIM (all p values were <0.05). Kaplan-Meier survival curves showed that CVD mortality was greater in patients with higher VIM (p = 0.05), whereas all-cause mortality had no significant difference between the four groups overall (p = 0.149). Furthermore, multivariate regression analyses demonstrated that VIM (HR = 1.091, p < 0.004) and age (HR = 1.059, p = 0.003) were significant independent predictors for CVD death. Logistic-regression models revealed that higher VIM groups were more likely to have CVD-related hospitalization (OR = 1.085, p = 0.030), whereas the association between VIM and all-cause hospitalization was not statistically significant (OR = 1.015, p = 0.669).
This retrospective study suggested that higher intradialytic BPV was associated with increasing age, longer dialysis vintage, lower albumin, and greater ultrafiltration; intradialytic BPV could be an effective predictor for CVD mortality and hospitalization in the HD population.
研究表明，透析前血压变异性（BPV）是血液透析（HD）患者心血管疾病（CVD）的独立危险因素，但关于透析中BPV如何影响预后的研究有限。
在本研究中，我们设计了一项回顾性队列研究，以检验HD患者透析中BPV与CVD结局之间的关联。纳入了在我们中心接受HD治疗的202例患者，并从数据库中获取了2017年11月所有透析中的血压测量值。根据均值独立变异系数（VIM）四分位数间距将患者分为四组。
平均年龄为62.1±14.3岁，男性占60.9%，VIM中位数为14.75（12.60 - 18.59）。多元回归分析显示，患者年龄、透析龄、血清白蛋白和透析中体重增加百分比是VIM的显著预测因素（所有p值均<0.05）。Kaplan-Meier生存曲线显示，VIM较高的患者CVD死亡率更高（p = 0.05），而四组患者的全因死亡率总体上无显著差异（p = 0.149）。此外，多因素回归分析表明，VIM（HR = 1.091，p < 0.004）和年龄（HR = 1.059，p = 0.003）是CVD死亡的显著独立预测因素。Logistic回归模型显示，VIM较高的组更有可能因CVD住院（OR = 1.085，p = 0.030），而VIM与全因住院之间的关联无统计学意义（OR = 1.015，p = 0.669）。
这项回顾性研究表明，较高的透析中BPV与年龄增长、透析龄延长、白蛋白降低和超滤增加有关；透析中BPV可能是HD人群CVD死亡率和住院率的有效预测指标。
