Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Clin Pract. 2022 Aug 1;2022:4214429. doi: 10.1155/2022/4214429. eCollection 2022.
Intradialytic hypotension (IDH) has been recognized as a serious and frequent complication during hemodialysis (HD) of end-stage renal disease (ESRD) patients, but the effect of asymptomatic IDH on cardiac troponin I (cTnI) levels is not definitively elucidated.
70 asymptomatic HD patients with negative predialysis cTnI were included. They were on maintenance HD thrice weekly. All patients were monitored during the HD session for hemodynamic changes and symptoms related to IDH. Patients were followed for two years, and their outcomes are noted as an acute coronary syndrome (ACS), cardiac death, no ACS, noncardiac death, and kidney transplant.
Compared with the baseline blood pressure values, there was a drop in systolic blood pressure for all subjects, but according to the 2007 European Best Practice Guidelines on hemodynamic instability, asymptomatic IDH was defined in 27 (38.6%) patients. The results demonstrated a significant correlation ( = 0.492) ( < 0.05) between asymptomatic IDH and elevated postdialysis levels of cTnI. In 2-year follow-up of patients, ACS and cardiac death happened more in patients with elevated cTnI.
The results of our study suggest that asymptomatic IDH affects cTnI levels. Given that cTnI is a marker of myocardial damage and a predictor of cardiovascular mortality in ESRD patients, these findings recommend that considering the asymptomatic decrease in blood pressure levels during HD is very important and critical.
透析中低血压（IDH）已被认为是终末期肾病（ESRD）患者血液透析（HD）过程中一种严重且频繁发生的并发症，但无症状 IDH 对心肌肌钙蛋白 I（cTnI）水平的影响尚未明确。
纳入 70 例无症状且透析前 cTnI 为阴性的 HD 患者，他们每周接受 3 次维持性 HD。所有患者在 HD 过程中均监测血流动力学变化和与 IDH 相关的症状。患者随访 2 年，记录其结局为急性冠脉综合征（ACS）、心脏死亡、无 ACS、非心脏死亡和肾移植。
与基线血压值相比，所有患者的收缩压均有所下降，但根据 2007 年欧洲最佳实践指南中关于血流动力学不稳定的定义，27 例（38.6%）患者被诊断为无症状 IDH。结果显示，无症状 IDH 与透析后 cTnI 水平升高之间存在显著相关性（ = 0.492）（ < 0.05）。在对患者 2 年的随访中，cTnI 升高的患者发生 ACS 和心脏死亡的情况更多。
本研究结果表明，无症状 IDH 会影响 cTnI 水平。鉴于 cTnI 是 ESRD 患者心肌损伤的标志物和心血管死亡率的预测因子，这些发现表明，在 HD 期间考虑无症状血压下降非常重要且关键。
