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透析期间血压变化与心脑血管事件之间的关联

Association Between Blood Pressure Variation During Dialysis and Cardio-Cerebrovascular Events.

作者信息

Fan Zhenliang, Ye Rujia, Yang Qiaorui, Yang Mengfan, Yin Riping, Zhao Dongxue, Fan Junfen, Ma Hongzhen, Shen Yiwei, Xia Hong, Jiang Wenze, Lu Keda

机构信息

Nephrology Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.

Academy of Chinese Medical Science, Zhejiang Chinese Medical University, Hangzhou, China.

出版信息

J Clin Hypertens (Greenwich). 2025 Jan;27(1):e14934. doi: 10.1111/jch.14934. Epub 2024 Dec 10.

DOI:10.1111/jch.14934
PMID:39654485
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11774084/
Abstract

In hemodialysis patients, blood pressure variability (BPV) is associated with cardiovascular events and all-cause mortality. However, previous research has predominantly concentrated on the predialysis BPV. In contrast, intradialytic BPV, reflecting the cardiovascular regulatory function during the process of rapid clearance of volume overload, holds greater relevance to the prognosis of patients. In this study, a latent category trajectory model was used to identify the patterns of intradialytic BPV and analyze the association between intradialytic BPV and the cardio-cerebrovascular events and other clinical outcomes. We found the variation of intradialytic systolic blood pressure (SBP) was associated with the risk of cardio-cerebrovascular events in hemodialysis patients. Patients in "SBP Class 4" and "SBP Class 3" subgroups were associated with the occurrence of cardio-cerebrovascular events and the number of cardio-cerebrovascular event hospitalizations during the follow-up period. This indicates that the variation pattern of intradialytic SBP results from the comprehensive action of various BP regulatory mechanisms in the body, which can reflect the level of cardiovascular regulatory function in hemodialysis patients and serve as a predictor of recent adverse cardio-cerebrovascular events.

摘要

在血液透析患者中,血压变异性(BPV)与心血管事件和全因死亡率相关。然而,以往的研究主要集中在透析前的BPV。相比之下,透析中BPV反映了在快速清除容量超负荷过程中的心血管调节功能,与患者的预后更相关。在本研究中,使用潜在类别轨迹模型来识别透析中BPV的模式,并分析透析中BPV与心脑血管事件及其他临床结局之间的关联。我们发现,血液透析患者透析中收缩压(SBP)的变化与心脑血管事件风险相关。“SBP 4级”和“SBP 3级”亚组的患者与随访期间心脑血管事件的发生以及心脑血管事件住院次数相关。这表明,透析中SBP的变化模式是机体各种血压调节机制综合作用的结果,能够反映血液透析患者的心血管调节功能水平,并可作为近期不良心脑血管事件的预测指标。

相似文献

1
Association Between Blood Pressure Variation During Dialysis and Cardio-Cerebrovascular Events.透析期间血压变化与心脑血管事件之间的关联
J Clin Hypertens (Greenwich). 2025 Jan;27(1):e14934. doi: 10.1111/jch.14934. Epub 2024 Dec 10.
2
A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension.有透析中高血压与无透析中高血压的血液透析患者短期血压变异性的比较研究。
Am J Nephrol. 2018;48(4):295-305. doi: 10.1159/000493989. Epub 2018 Oct 22.
3
Hemodialysis patients with intradialytic rise in blood pressure display higher baseline aortic stiffness and negligible drop in augmentation index with dialysis.透析期间血压升高的血液透析患者表现出更高的基线主动脉僵硬度,且透析时增强指数下降可忽略不计。
Int Urol Nephrol. 2016 Apr;48(4):601-8. doi: 10.1007/s11255-015-1205-8. Epub 2016 Jan 14.
4
Blood pressure variability is increasing from the first to the second day of the interdialytic interval in hemodialysis patients.血液透析患者在透析间隔的第一天到第二天之间,血压变异性增加。
J Hypertens. 2017 Dec;35(12):2517-2526. doi: 10.1097/HJH.0000000000001478.
5
Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients.血液透析患者透析期间血压及其变异性与心血管事件的关联
Kidney Blood Press Res. 2018;43(4):1352-1362. doi: 10.1159/000492595. Epub 2018 Aug 10.
6
Hemodynamic and pathophysiological characteristics of intradialytic blood pressure elevation in patients with end-stage renal disease.终末期肾病患者透析中血压升高的血液动力学和病理生理学特征。
Hypertens Res. 2014 Feb;37(2):158-65. doi: 10.1038/hr.2013.123. Epub 2013 Sep 19.
7
Intradialytic systolic blood pressure variation can predict long-term mortality in patients on maintenance hemodialysis.透析中收缩压变异性可预测维持性血液透析患者的长期死亡率。
Int Urol Nephrol. 2021 Apr;53(4):785-795. doi: 10.1007/s11255-020-02701-w. Epub 2021 Jan 2.
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Nebivolol reduces short-term blood pressure variability more potently than irbesartan in patients with intradialytic hypertension.比卡洛尔比厄贝沙坦更能降低透析中高血压患者的短期血压变异性。
Hypertens Res. 2019 Jul;42(7):1001-1010. doi: 10.1038/s41440-018-0194-2. Epub 2019 Jan 8.
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[Related factors and prognostic significance of intradialytic blood pressure variability in patients on maintenance hemodialysis].维持性血液透析患者透析中血压变异性的相关因素及预后意义
Zhonghua Nei Ke Za Zhi. 2013 Jun;52(6):453-8.
10
Lung Ultrasound-Guided Dry-Weight Reduction in Hemodialysis Patients Does Not Affect Short-Term Blood Pressure Variability.超声引导下经肺脱水对血液透析患者的短期血压变异性无影响。
Am J Hypertens. 2019 Jul 17;32(8):786-795. doi: 10.1093/ajh/hpz064.

本文引用的文献

1
The superiority of bioimpedance vs. echocardiography and pitting edema in predicting automated office blood pressure in continuous ambulatory peritoneal dialysis patients.生物阻抗相对于超声心动图和凹陷性水肿在预测持续不卧床腹膜透析患者自动诊室血压中的优势。
Ther Apher Dial. 2024 Apr;28(2):272-283. doi: 10.1111/1744-9987.14074. Epub 2023 Oct 18.
2
Short-term blood pressure variability as a potential therapeutic target for kidney disease.短期血压变异性作为肾脏疾病的潜在治疗靶点。
Clin Hypertens. 2023 Aug 15;29(1):23. doi: 10.1186/s40885-023-00248-3.
3
Blood Pressure Variability in Clinical Practice: Past, Present and the Future.
临床实践中的血压变异性:过去、现在和未来。
J Am Heart Assoc. 2023 May 2;12(9):e029297. doi: 10.1161/JAHA.122.029297. Epub 2023 Apr 29.
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Resistant hypertension in dialysis.透析患者的耐药性高血压。
Nephrol Dial Transplant. 2023 Aug 31;38(9):1952-1959. doi: 10.1093/ndt/gfad047.
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Hypertension in Chronic Kidney Disease: An Update on Diagnosis and Management.慢性肾脏病中的高血压:诊断与管理的最新进展
South Med J. 2023 Feb;116(2):237-244. doi: 10.14423/SMJ.0000000000001516.
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Long-term predialysis blood pressure variability and outcomes in hemodialysis patients.血液透析患者透析前血压变异性与预后的关系。
J Clin Hypertens (Greenwich). 2022 Feb;24(2):148-155. doi: 10.1111/jch.14398. Epub 2022 Jan 28.
7
Intradialytic BP variability is associated with cardiovascular mortality and hospitalization in HD patients.透析期间血压变异性与血液透析患者的心血管死亡率及住院率相关。
Ther Apher Dial. 2022 Jun;26(3):624-631. doi: 10.1111/1744-9987.13745. Epub 2021 Oct 20.
8
Long-Term Blood Pressure Variability and Kidney Function in Participants of the ASPREE Trial.ASPREE 试验参与者的长期血压变异性与肾功能。
Am J Hypertens. 2022 Feb 1;35(2):173-181. doi: 10.1093/ajh/hpab143.
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[Blood pressure variability in hemodialysis patients: prognostic significance and treatment possibilities].
Ter Arkh. 2020 May 19;92(4):91-97. doi: 10.26442/00403660.2020.04.000534.
10
How important is blood pressure variability?血压变异性有多重要?
Eur Heart J Suppl. 2020 Jun;22(Suppl E):E1-E6. doi: 10.1093/eurheartj/suaa061. Epub 2020 Apr 6.