Mayer Christopher C, Sarafidis Pantelis A, Matschkal Julia, Theodorakopoulou Marieta, Lorenz Georg, Karagiannidis Artemios, Angermann Susanne, Iatridi Fotini, Braunisch Matthias C, Karpetas Antonios, Baumann Marcus, Pella Eva, Heemann Uwe, Wassertheurer Siegfried, Schmaderer Christoph
AIT Austrian Institute of Technology, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria.
TU Wien, Institute for Analysis and Scientific Computing, Vienna, Austria.
Clin Kidney J. 2024 Jun 27;17(7):sfae172. doi: 10.1093/ckj/sfae172. eCollection 2024 Jul.
Risk prediction in haemodialysis (HD) patients is challenging due to the impact of the dialysis regime on the patient's volume status and the complex interplay with cardiac function, comorbidities and hypertension. Cardiac function as a key predictor of cardiovascular (CV) mortality in HD patients is challenging to assess in daily routine. Thus the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal.
A total of 558 (373 male/185 female) HD patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring, including wave intensity analysis [i.e. S:D ratio (SDR)]. All-cause and CV mortality served as endpoints and multivariate proportional hazards models were used for risk prediction. Intradialytic changes were analysed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to CV reasons).
The SDR was significantly associated with all-cause {univariate hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.20-1.54], < .001} and CV [univariate HR 1.41 (95% CI 1.20-1.67), < .001] mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in the SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups.
This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.
由于透析方案对患者容量状态的影响以及与心功能、合并症和高血压之间复杂的相互作用，血液透析（HD）患者的风险预测具有挑战性。心功能作为HD患者心血管（CV）死亡率的关键预测指标，在日常临床中评估具有挑战性。因此，本研究的目的是探讨一种新的、非侵入性的收缩功能相对指标与死亡率的关联，并评估其与容量清除的相互作用。
本分析纳入了558例（373例男性/185例女性）HD患者，中位年龄为66岁。他们接受了24小时动态血压监测，包括波强度分析[即S:D比值（SDR）]。全因死亡率和CV死亡率作为终点，采用多变量比例风险模型进行风险预测。根据超滤量将透析期间的变化分为三分位数进行分析。在37.8个月的随访期间，193例患者死亡（92例死于CV原因）。
SDR与全因死亡率{单变量风险比[HR]1.36[95%置信区间（CI）1.20 - 1.54]，P <.001}和CV死亡率[单变量HR 1.41（95%CI 1.20 - 1.67），P <.001]显著相关。在考虑了可能的混杂因素的多变量分析中，这种关联仍然显著。三个超滤量组从透析前/早期到透析后平均SDR的变化有显著差异。
本研究为一种新的收缩功能指标与死亡率的独立关联提供了有力证据。此外，它还揭示了该指标在透析期间的变化与透析期间容量清除之间的显著关联。
