Sági Balázs, Vas Tibor, Jakabfi-Csepregi Rita Klaudia, Sulyok Endre, Csiky Botond
2nd Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, Pacsirta Street 1, 7624 Pécs, Hungary.
National Dialysis Center Pécs, 7624 Pécs, Hungary.
J Clin Med. 2024 Oct 7;13(19):5958. doi: 10.3390/jcm13195958.
Cardiovascular (CV) diseases are the most common causes of morbidity and mortality in hemodialysis (HD) patients. We studied the effect of high visit-to-visit ultrafiltration (UF) variability on CV abnormalities in HD patients. Twenty-nine consecutive patients (age: 65.6 ± 10.4 years) were recruited. Samples for routine lab tests were drawn pre-HD for syndecan-1 (SDC-1) and endothelin-1 (ET-1) measurements pre-, mid- and post-HD. Applanation tonometry was performed pre-, mid- and post-HD. Visit-to-visit ultrafiltration volume variability (UVSD) was calculated as the standard deviation of the UF volume/dialysis session in the preceding 12 months. Echocardiography was performed post-HD. Patients were divided into two groups based on the median of UVSD (500 mL). The average UF volume/HD was not different between the groups. Blood pressure (BP) values were similar. Pre-HD cfPWV (10.75 m/s) was lower in the high UVSD group (14.1 m/s, = 0.03). In the high UVSD group, post-HD cfPWV (13.9 m/s) was higher than the pre-HD cfPWV ( < 0.05). Pre-HD ET-1 was lower in the high UVSD group (8.6 ± 3.9 vs. 10.8 ± 2.7 pg/mL, < 0.05). Left ventricular end-diastolic diameter (LVEDD) and left ventricular mass index (LVMI) were higher in the high UVSD group (55.7 ± 7.3 vs. 51.0 ± 5.4 mm and 449.9 ± 180.5 vs. 350.3 ± 85.9 g/m², < 0.005, respectively). Left ventricular ejection fraction (LVEF) was lower in the high UVSD group (53.5 vs. 60, < 0.05). High UVSD was associated with increased left ventricular hypertrophy and dysfunction and decreased LVEF compared to low visit-to-visit UV variability despite similar UF volumes temporarily compensated by more elastic arteries. The observed abnormalities may increase CV risk.
心血管（CV）疾病是血液透析（HD）患者发病和死亡的最常见原因。我们研究了高透析间期超滤（UF）变异性对HD患者心血管异常的影响。招募了29例连续患者（年龄：65.6±10.4岁）。在HD前采集用于常规实验室检查的样本，以测量HD前、中、后的 syndecan-1（SDC-1）和内皮素-1（ET-1）。在HD前、中、后进行压平眼压测量。透析间期超滤量变异性（UVSD）计算为前12个月内每次透析 session 的超滤量的标准差。HD后进行超声心动图检查。根据UVSD的中位数（500 mL）将患者分为两组。两组间平均超滤量/HD无差异。血压（BP）值相似。高UVSD组HD前的cfPWV（10.75 m/s）低于低UVSD组（14.1 m/s，P = 0.03）。在高UVSD组中，HD后的cfPWV（13.9 m/s）高于HD前（P < 0.05）。高UVSD组HD前的ET-1较低（8.6±3.9 vs. 10.8±2.7 pg/mL，P < 0.05）。高UVSD组的左心室舒张末期直径（LVEDD）和左心室质量指数（LVMI）较高（分别为55.7±7.3 vs. 51.0±5.4 mm和449.9±180.5 vs. 350.3±85.9 g/m²，P < 0.005）。高UVSD组的左心室射血分数（LVEF）较低（53.5 vs. 60，P < 0.05）。与透析间期UV变异性低的情况相比，尽管超滤量相似，但通过更具弹性的动脉暂时得到补偿，高UVSD与左心室肥厚和功能障碍增加以及LVEF降低相关。观察到的异常可能会增加CV风险。
