Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Dialysis Center, Renmin Hospital of Wuhan University, Wuhan, China.
Headache. 2024 Mar;64(3):285-298. doi: 10.1111/head.14688. Epub 2024 Mar 1.
Hemodialysis headache (HDH) is a common complication of dialysis that negatively affects the patient's quality of life. The etiology and triggering factors of HDH are not fully understood. This study aims to assess the prevalence and characteristics of HDH among patients undergoing hemodialysis across multiple centers in China. Furthermore, we conducted a case-control study at one hospital to identify risk factors associated with HDH.
The study consisted of two phases including a cross-sectional observational study and a case-control study. Participants underwent neurological examinations and interviews. Demographic and medical information were collected from both medical records and patient files. Serum creatinine, uric acid, urea, estimated glomerular filtration rate (eGFR), plasma osmolarity, glucose, C1q, and a variety of electrolytes including potassium, sodium, chloride, calcium, magnesium, and phosphorus were measured before and after dialysis. Blood pressure variables including systolic blood pressure, diastolic blood pressure, pulse pressure (PP), and heart rate were monitored hourly. Serum levels of inflammatory factors, including tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-4, IL-6, and IL-10 were quantified using a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA).
The prevalence of HDH was 37.7% (183/485). HDH was characterized by a bilateral tightening headache of moderate intensity and duration of <2 h, occurring in different locations. The case-control study included 50 patients with HDH and 84 control patients, pre-dialysis PP was found to be lower in the HDH group than in the control group (mean ± standard deviation 51.5 ± 18.2 vs. 67.9 ± 14.9, p = 0.027). Furthermore, the pre-dialysis serum complement C1q level was significantly higher for the HDH group than the control group (median and interquartile range 201.5 [179.0-231.5] vs. 189.0 [168.9-209.0], p = 0.021). Pre-dialysis PP was associated with 5.1% decreased odds of HDH (odds ratio [OR] = 0.96; 95% confidence interval [CI], 0.93-0.99, p = 0.026), body weight was associated with a 5.4% decreased risk of HDH (OR = 0.95; 95% CI, 0.91-0.99, p = 0.013), and pre-dialysis C1q levels increased the odds of HDH by 1.9% (OR = 1.02; 95% CI, 1.01-1.03, p = 0.005).
Low PP, low body weight, and high blood complement C1q may be potential risk factors associated with HDH.
血液透析头痛（HDH）是透析的常见并发症，会对患者的生活质量产生负面影响。HDH 的病因和触发因素尚未完全阐明。本研究旨在评估中国多家中心血液透析患者 HDH 的患病率和特征。此外，我们在一家医院进行了病例对照研究，以确定与 HDH 相关的危险因素。
该研究包括两个阶段，包括横断面观察性研究和病例对照研究。参与者接受了神经学检查和访谈。从病历和患者档案中收集了人口统计学和医学信息。在透析前后测量了血清肌酐、尿酸、尿素、估算肾小球滤过率（eGFR）、血浆渗透压、葡萄糖、C1q 和各种电解质，包括钾、钠、氯、钙、镁和磷。每小时监测血压变量，包括收缩压、舒张压、脉压（PP）和心率。使用双抗体夹心酶联免疫吸附试验（ELISA）定量测定血清炎症因子水平，包括肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-4、IL-6 和 IL-10。
HDH 的患病率为 37.7%（183/485）。HDH 的特征是双侧紧张性头痛，中度强度，持续时间<2 小时，发生在不同部位。病例对照研究包括 50 例 HDH 患者和 84 例对照患者，发现 HDH 组的预透析 PP 低于对照组（平均值±标准差 51.5±18.2 对 67.9±14.9，p=0.027）。此外，HDH 组的预透析血清补体 C1q 水平明显高于对照组（中位数和四分位距 201.5[179.0-231.5]对 189.0[168.9-209.0]，p=0.021）。预透析 PP 与 HDH 发生几率降低 5.1%相关（比值比[OR]＝0.96；95%置信区间[CI]，0.93-0.99，p=0.026），体重与 HDH 发生风险降低 5.4%相关（OR＝0.95；95%CI，0.91-0.99，p=0.013），预透析 C1q 水平升高与 HDH 发生几率增加 1.9%相关（OR＝1.02；95%CI，1.01-1.03，p=0.005）。
低 PP、低体重和高血液补体 C1q 可能是与 HDH 相关的潜在危险因素。
