Renal Division, Department of Medicine, Brigham and Women's Hospital, Medical School, Boston, Massachusetts.
Renal Division, Department of Medicine, Brigham and Women's Hospital, Medical School, Boston, Massachusetts.
Am J Kidney Dis. 2023 Jun;81(6):647-654. doi: 10.1053/j.ajkd.2022.11.007. Epub 2022 Dec 29.
RATIONALE & OBJECTIVE: Intradialytic hypotension and intradialytic hypertension are associated with morbidity and mortality in hemodialysis (HD). Many factors can contribute to intra-HD blood pressure (BP) changes, such as drugs with vasoactive properties that can destabilize an already tenuous BP. Intravenous iron sucrose is commonly administered to correct iron deficiency; however, its reported associations with altered hemodynamics have not been consistent.
Prospective cohort study.
SETTING & PARTICIPANTS: 950 outpatients receiving maintenance HD.
Iron sucrose administered during HD.
Intradialytic hypotension, intradialytic hypertension, systolic blood pressure parameters.
Unadjusted and adjusted Poisson and linear repeated measures regression models.
The mean age of patients included in the study was 53±22 years, 43% were female, and 38% were Black. Mean pre-HD SBP was 152±26 (SD) mm Hg. At baseline, the patients who received higher doses of iron sucrose tended to have diabetes, have longer HD sessions, and have a higher frequency of erythropoiesis-stimulating agent use, compared with those who did not receive iron sucrose. In adjusted models, higher doses of iron sucrose were associated with an 11% lower rate of intradialytic hypotension (incidence rate ratio [IRR] for iron sucrose≥100mg vs 0 mg, 0.89 [95% CI, 0.85-0.94]). In adjusted analyses, the administration of higher doses of iron sucrose during HD was associated with intradialytic hypertension (IRR for iron sucrose≥100mg vs 0 mg, 1.07 [95% CI, 1.04-1.10]).
Nonavailability of the precise iron sucrose formulation (volume), laboratory data for each HD session, and outpatient medications. Objective measures of volume status, home medications, and symptom data were not recorded in this study.
We observed an independent association of intravenous iron sucrose administration during HD with a lower risk of intradialytic hypotension and higher risk of intradialytic hypertension. Future studies to better understand the mechanisms underlying these associations are warranted.
PLAIN-LANGUAGE SUMMARY: Intradialytic hypotension and intradialytic hypertension are common among patients on hemodialysis, and they are associated with morbidity and mortality. Although many factors may contribute to these risks, medications administered during hemodialysis play an important role. We studied the significance of the intravenous iron sucrose used to treat iron deficiency and the impact it may have on blood pressure during dialysis. In our study of 950 outpatient hemodialysis patients, we observed that administration of iron sucrose was associated with higher systolic blood pressure (during and after hemodialysis sessions) as well as a lower risk of intradialytic hypotension. We also observed that higher doses of iron sucrose are associated with the development of intradialytic hypertension.
透析中低血压和透析中高血压与血液透析（HD）患者的发病率和死亡率相关。许多因素可导致 HD 期间血压（BP）的变化，例如具有血管活性的药物可能使已经不稳定的血压进一步恶化。静脉注射蔗糖铁通常用于纠正缺铁；然而，其与血液动力学改变的相关报告并不一致。
前瞻性队列研究。
950 名接受维持性 HD 的门诊患者。
HD 期间给予蔗糖铁。
透析中低血压、透析中高血压、收缩压参数。
未调整和调整后的泊松和线性重复测量回归模型。
纳入研究的患者平均年龄为 53±22 岁，43%为女性，38%为黑人。HD 前的平均 SBP 为 152±26（SD）mmHg。在基线时，接受较高剂量蔗糖铁的患者往往患有糖尿病，HD 时间较长，并且更频繁地使用促红细胞生成素刺激剂，与未接受蔗糖铁的患者相比。在调整后的模型中，较高剂量的蔗糖铁与透析中低血压的发生率降低 11%相关（蔗糖铁剂量≥100mg 与 0mg 的发生率比 [IRR]，0.89[95%CI，0.85-0.94]）。在调整分析中，HD 期间给予较高剂量的蔗糖铁与透析中高血压相关（蔗糖铁剂量≥100mg 与 0mg 的发生率比 [IRR]，1.07[95%CI，1.04-1.10]）。
无法获得确切的蔗糖铁配方（体积）、每次 HD 治疗的实验室数据以及门诊药物。本研究未记录 HD 期间蔗糖铁给药的客观容量状态、家庭用药和症状数据。
我们观察到 HD 期间静脉内给予蔗糖铁与透析中低血压风险降低和透析中高血压风险升高独立相关。需要进一步的研究来更好地了解这些关联的潜在机制。
透析中低血压和透析中高血压在血液透析患者中很常见，与发病率和死亡率相关。尽管许多因素可能导致这些风险，但在血液透析期间给予的药物起着重要作用。我们研究了用于治疗缺铁的静脉内蔗糖铁的意义及其对透析期间血压的影响。在我们对 950 名门诊血液透析患者的研究中，我们观察到蔗糖铁的给药与较高的收缩压（在透析期间和之后）以及透析中低血压的风险降低相关。我们还观察到，较高剂量的蔗糖铁与透析中高血压的发生相关。
