透析液钾浓度对透析中高血压影响的随机试验

Randomized Trial on the Effects of Dialysate Potassium Concentration on Intradialytic Hypertension.

作者信息

Vongchaiudomchoke Thanawat, Aviphan Kanawat, Sanyakeun Nopparat, Wachiraphansakul Nuttaya, Sawangduan Vittawin, Nochaiwong Surapon, Ruengorn Chidchanok, Noppakun Kajohnsak

机构信息

Department of Internal Medicine, Lampang Hospital, Lampang, Thailand.

Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

出版信息

Kidney Int Rep. 2023 Apr 11;8(7):1323-1331. doi: 10.1016/j.ekir.2023.04.005. eCollection 2023 Jul.

DOI:10.1016/j.ekir.2023.04.005

PMID:37441490

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10334342/

Abstract

INTRODUCTION

Intradialytic hypertension is not an uncommon condition during chronic hemodialysis. It is associated with unfavorable cardiovascular outcomes, including hospitalization and mortality. Several small studies have demonstrated the contradictory effects of different dialysate potassium concentrations on intradialytic blood pressure. This study is a randomized crossover trial aiming to evaluate the effects of different dialysate potassium concentrations on intradialytic hypertension.

METHODS

A 24-week, 2-treatment, 4-sequence, multicenter, double-blinded, randomized, crossover study was conducted at Maharaj Nakorn Chiang Mai Hospital and Lampang Hospital in Thailand among stable patients receiving chronic hemodialysis who experienced intradialytic hypertension >30% of their sessions over the past 3 months. Each participant was randomly assigned to 1 of 4 treatment sequences. During each intervention period, patients were dialyzed with dialysate potassium of either 2 mmol/l (D-K2) or 3 mmol/l (D-K3) for 4 weeks according to their preassigned sequence, separated by a 2-week washout period. The primary outcome was the incidence of intradialytic hypertension.

RESULTS

Forty eligible patients were recruited. The mean age was 61.4 ± 14.2 years and the mean systolic blood pressure (SBP) was 146.6 ± 11.2 mm Hg. Of the 40 patients, 95.5% had hypertension and their average number of antihypertensive drugs was 2.8 ± 1.9. A total of 1380 dialysis sessions were included in the analysis (695 sessions for D-K2 and 685 sessions for D-K3). The incidence of intradialytic hypertension was not significantly different between different dialysate potassium concentrations (D-K2 54.7% vs. D-K3 53.1%, = 0.788). The changes in SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were not different between the 2 dialysate potassium groups.

CONCLUSION

Dialysate potassium concentration of 2 or 3 mmol/l did not affect the incidence of intradialytic hypertension in patients receiving chronic hemodialysis who frequently developed intradialytic hypertension.

摘要

引言

透析期间高血压在慢性血液透析过程中并不罕见。它与不良心血管结局相关，包括住院和死亡。几项小型研究表明，不同透析液钾浓度对透析期间血压有相互矛盾的影响。本研究是一项随机交叉试验，旨在评估不同透析液钾浓度对透析期间高血压的影响。

方法

在泰国清迈玛哈叻吉医院和南邦医院对过去3个月中透析期间高血压发作次数超过30%的稳定慢性血液透析患者进行了一项为期24周、2种治疗、4种序列、多中心、双盲、随机、交叉研究。每位参与者被随机分配到4种治疗序列中的1种。在每个干预期，患者根据预先指定的序列，用2 mmol/l（D-K2）或3 mmol/l（D-K3）的透析液钾进行4周透析，中间间隔2周的洗脱期。主要结局是透析期间高血压的发生率。

结果

招募了40名符合条件的患者。平均年龄为61.4±14.2岁，平均收缩压（SBP）为146.6±11.2 mmHg。40名患者中，95.5%患有高血压，他们平均服用的降压药数量为2.8±1.9。分析共纳入1380次透析治疗（D-K2组695次，D-K3组685次）。不同透析液钾浓度之间透析期间高血压的发生率无显著差异（D-K2组54.7% vs. D-K3组53.1%，P = 0.788）。两组透析液钾浓度之间SBP、舒张压（DBP）和平均动脉压（MAP）的变化无差异。