Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, PR China.
Division of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, PR China.
Ren Fail. 2024 Dec;46(2):2411367. doi: 10.1080/0886022X.2024.2411367. Epub 2024 Oct 8.
To determine the relationship of hemodialysis access with vital sign variability and hemodialysis-related headache (HRH). Adult outpatients receiving maintenance hemodialysis (MHD) were prospectively recruited, and 12 consecutive dialysis sessions were monitored. Intradialysis (hour-to-hour) and interdialysis (dialysis day-to-day) vital sign variabilities were assessed three metrics: the difference between the maximum and minimum values, average real variability (ARV), and residuals. Multivariate logistic regression analysis was used to explore the factors triggering HRH. A total of 91 Chinese MHD patients (60.4% male) aged 58.5 ± 17.2 years were included, with 59 patients using radiocephalic arteriovenous fistulas (RCAVFs) and 32 patients using tunneled cuffed catheters (TCCs) for dialysis. The median dialysis vintage was 26.8 (12.0-44.7) months. Compared with the RCAVF group, the TCC group had significantly greater urea reduction (71.1 ± 9.3% 61.7 ± 10.5%, < 0.001) and clearance (1.5 (1.2-1.8) 1.1 (1.0-1.4), < 0.001) rates, higher intradialysis pulse variability and lower intradialysis diastolic blood pressure variability. Some of interdialysis variability indexes in pulse, systolic blood pressure (SBP), and SpO2 were significantly greater in the TCC group than that in the RCAVF group. Age (OR = 0.880, 95% CI = 0.785-0.986, = 0.028), TCC use (OR = 22.257, 95% CI = 1.190-416.399, = 0.038), intradialysis SBP-ARV (OR = 2.768, 95% CI = 1.069-7.171, = 0.036), and blood sodium level (OR = 0.400, 95% CI = 0.192-0.832, = 0.014) were shown to be independent risk factors for HRH. In conclusion, the use of TCCs has multifaceted effects on intradialysis and interdialysis vital sign variabilities and is independently associated with an increased risk of HRH.
确定血液透析通路与生命体征变异性和血液透析相关头痛（HRH）的关系。方法：前瞻性招募接受维持性血液透析（MHD）的成年门诊患者，并监测 12 个连续的透析疗程。通过三个指标评估透析期间（小时内）和透析间隔期（透析日）的生命体征变异性：最大值与最小值之间的差异、平均真实变异性（ARV）和残差。采用多变量逻辑回归分析探讨触发 HRH 的因素。结果：共纳入 91 名中国 MHD 患者（60.4%为男性），年龄 58.5±17.2 岁，59 名患者使用桡动脉-头静脉动静脉瘘（RCAVF），32 名患者使用隧道带袖套导管（TCC）进行透析。中位透析龄为 26.8（12.0-44.7）个月。与 RCAVF 组相比，TCC 组的尿素清除率（71.1±9.3% 61.7±10.5%，<0.001）和清除率（1.5（1.2-1.8） 1.1（1.0-1.4），<0.001）更高，透析期间脉压变异性更大，透析期间舒张压变异性更小。TCC 组的一些透析间隔期变异性指标在脉搏、收缩压（SBP）和 SpO2 方面明显大于 RCAVF 组。年龄（OR=0.880，95%CI=0.785-0.986，P=0.028）、TCC 使用（OR=22.257，95%CI=1.190-416.399，P=0.038）、透析期间 SBP-ARV（OR=2.768，95%CI=1.069-7.171，P=0.036）和血钠水平（OR=0.400，95%CI=0.192-0.832，P=0.014）是 HRH 的独立危险因素。结论：TCC 的使用对透析期间和透析间隔期的生命体征变异性有多种影响，并且与 HRH 的风险增加独立相关。
