2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Hemodialysis Unit, General Hospital of Xanthi, Xanthi, Greece.
Ther Apher Dial. 2024 Oct;28(5):697-705. doi: 10.1111/1744-9987.14142. Epub 2024 May 14.
Prior observational studies conducted in the hemodialysis population have suggested a reverse association between dialysis-unit blood pressure (BP) and mortality. The present study aimed to investigate the prognostic association of home versus dialysis-unit BP with all-cause mortality in hemodialysis patients.
At baseline, 146 patients receiving maintenance hemodialysis underwent assessment of their BP with the following methods: (i) 2-week averaged routine predialysis and postdialysis BP measurements; (ii) home BP monitoring for 1 week that included duplicate morning and evening BP measurements with the use of validated devices.
Over a median follow-up period of 38 months (interquartile range [IQR]: 22-54), 44 patients (31.1%) died. In Kaplan-Meier curves, predialysis and postdialysis systolic BP (SBP) was not associated with all-cause mortality, while home SBP appeared to be of prognostic significance (log rank p = 0.029). After stratifying patients into quartiles, all-cause mortality was lowest when home SBP was ranging from 128.1 to 136.8 mmHg (quartile 2). In univariate Cox regression analysis, using quartile 2 as a referent category, the risk of all-cause mortality was 3.32-fold higher in quartile 1, 1.53-fold higher in quartile 3 and 3.25-fold higher in quartile 4. The risk-association remained unchanged after adjustment for several confounding factors (adjusted hazard ratio: 4.79, 1.79, 3.63 for quartiles 1, 3, and 4 of home systolic BP, respectively).
Our findings suggest that among hemodialysis patients, 1-week averaged home SBP is independently associated with all-cause mortality. In sharp contrast, SBP recorded either before or after dialysis over 2 weeks is not prognostically informative.
先前在血液透析人群中进行的观察性研究表明，透析单位血压（BP）与死亡率之间呈反向关系。本研究旨在探讨家庭与透析单位 BP 与血液透析患者全因死亡率的预后相关性。
在基线时，146 名接受维持性血液透析的患者接受了以下方法的 BP 评估：（i）2 周平均常规透析前和透析后 BP 测量；（ii）使用经过验证的设备进行为期 1 周的家庭 BP 监测，包括重复的早晨和晚上 BP 测量。
在中位数为 38 个月（四分位距[IQR]：22-54）的随访期间，44 名患者（31.1%）死亡。在 Kaplan-Meier 曲线中，透析前和透析后收缩压（SBP）与全因死亡率无关，而家庭 SBP 似乎具有预后意义（对数秩 p=0.029）。在将患者分层为四分位后，当家庭 SBP 范围在 128.1 至 136.8mmHg 时（四分位 2），全因死亡率最低。在单变量 Cox 回归分析中，使用四分位 2 作为参考类别，四分位 1 的全因死亡率风险是四分位 2 的 3.32 倍，四分位 3 的全因死亡率风险是四分位 2 的 1.53 倍，四分位 4 的全因死亡率风险是四分位 2 的 3.25 倍。在调整了几个混杂因素后，风险关联保持不变（四分位 1、3 和 4 的调整后危险比分别为 4.79、1.79 和 3.63）。
我们的研究结果表明，在血液透析患者中，1 周平均家庭 SBP 与全因死亡率独立相关。与此形成鲜明对比的是，在 2 周内透析前后记录的 SBP 并不能提供预后信息。
