血液透析期间生物电阻抗参数与血压升高的关联

Association of Bioimpedance Parameters with Increases in Blood Pressure during Hemodialysis.

作者信息

Elsayed Enass, Farag Youssef M K, Ravi Katherine Scovner, Chertow Glenn M, Mc Causland Finnian R

机构信息

Brigham and Women's Hospital, Boston, Massachusetts.

Harvard Medical School, Boston, Massachusetts.

出版信息

Clin J Am Soc Nephrol. 2024 Mar 1;19(3):329-335. doi: 10.2215/CJN.0000000000000356. Epub 2023 Nov 16.

DOI:10.2215/CJN.0000000000000356

PMID:37971865

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10937019/

Abstract

BACKGROUND

Intradialytic hypertension, defined as an increase in BP from pre- to post-hemodialysis (HD), affects 5%-15% of patients receiving maintenance HD and is associated with cardiovascular and all-cause mortality. Hypervolemia is believed to be a major etiological factor, yet the association of more objective biomarkers of volume status with intradialytic hypertension is not well described.

METHODS

In a post hoc analysis of the Frequent Hemodialysis Network Daily Trial ( n =234), using data from baseline, 1-, 4-, and 12-month visits ( n =800), we used random-effects regression to assess the association of bioimpedance estimates of volume (vector length) with post-HD systolic BP (continuous) and any increase in systolic BP (categorical) from pre- to post-HD. We adjusted models for randomized group; age; sex; self-reported race; Quételet (body mass) index; vascular access; HD vintage; hypertension; history of heart failure; diabetes; residual kidney function (urea clearance); pre-HD systolic BP; ultrafiltration rate; serum-dialysate sodium gradient; and baseline values of hemoglobin, phosphate, and equilibrated Kt/V urea.

RESULTS

The mean age of participants was 50±14 years, 39% were female, and 43% were Black. In adjusted models, shorter vector length (per 50 Ω/m) was associated with higher post-HD systolic BP (2.9 mm Hg; 95% confidence interval [CI], 1.6 to 4.3) and higher odds of intradialytic hypertension (odds ratio 1.66; 95% CI, 1.07 to 2.55). Similar patterns of association were noted with a more stringent definition of intradialytic hypertension (>10 mm Hg increase from pre- to post-HD systolic BP), where shorter vector length (per 50 Ω/m) was associated with a higher odds of intradialytic hypertension (odds ratio 2.17; 95% CI, 0.88 to 5.36).

CONCLUSIONS

Shorter vector length, a bioimpedance-derived proxy of hypervolemia, was independently associated with higher post-HD systolic BP and risk of intradialytic hypertension.

摘要

背景

透析期间高血压定义为血液透析（HD）前后血压升高，影响5%-15%接受维持性血液透析的患者，并与心血管和全因死亡率相关。高血容量被认为是主要病因，但容量状态的更客观生物标志物与透析期间高血压的关联尚未得到充分描述。

方法

在频繁血液透析网络每日试验（n = 234）的事后分析中，使用基线、1个月、4个月和12个月访视（n = 800）的数据，我们采用随机效应回归来评估容量生物阻抗估计值（向量长度）与透析后收缩压（连续变量）以及透析前后收缩压的任何升高（分类变量）之间的关联。我们对模型进行了如下调整：随机分组；年龄；性别；自我报告的种族；体重指数；血管通路；透析龄；高血压；心力衰竭病史；糖尿病；残余肾功能（尿素清除率）；透析前收缩压；超滤率；血清-透析液钠梯度；以及血红蛋白、磷酸盐和平衡的Kt/V尿素的基线值。

结果

参与者的平均年龄为50±14岁，39%为女性，43%为黑人。在调整后的模型中，较短的向量长度（每50 Ω/m）与较高的透析后收缩压（2.9 mmHg；95%置信区间[CI]，1.6至4.3）以及透析期间高血压的较高几率相关（比值比1.66；95% CI，1.07至2.55）。对于透析期间高血压的更严格定义（透析前后收缩压升高>10 mmHg），也观察到了类似的关联模式，其中较短的向量长度（每50 Ω/m）与透析期间高血压的较高几率相关（比值比2.17；95% CI，0.88至5.36）。