Iseki K, Miyasato F, Tokuyama K, Nishime K, Uehara H, Shiohira Y, Sunagawa H, Yoshihara K, Yoshi S, Toma S, Kowatari T, Wake T, Oura T, Fukiyama K
Third Department of Internal Medicine, University of The Ryukyus, Okinawa, Japan.
Kidney Int. 1997 Apr;51(4):1212-7. doi: 10.1038/ki.1997.165.
In a previous report, we showed that nutritional status and especially serum albumin had great predictive value for death in chronic hemodialysis patients, whereas blood pressure did not. In the present study, we analyzed the causes of death in consideration of the relationship between serum albumin and blood pressure. A total of 1,243 Okinawan patients (719 males, 524 females) undergoing hemodialysis in January 1991 were followed up through the end of 1995. Three hundred forty-two of the patients died, 45 received transplants, and 12 were transferred by the end of the follow-up period. The total duration of observation was 5,110.3 patient-years. Blood pressure as well as clinical and laboratory variables were determined immediately prior to the first dialysis session in January 1991. The crude death rate was 40.0% when the diastolic blood pressure (DBP) <70 mm Hg, 35.0% at 70 to 79 mm Hg, 25.0% at 80 to 89 mm Hg, 25.0% at 90 to 99 mm Hg, and 13.0% at >100 mm Hg. The death rate showed an inverse correlation with DBP. DBP showed a significant positive correlation with serum albumin (r = 0.137, P < 0.001) and age (r = -0.325, P < 0.0001). The adjusted odds ratio (95% confidence interval) of death was 0.84 (0.71 to 0.99) with 10 mm Hg increments in DBP when the reference DBP was less than 69 mm Hg. Low DBP may be a manifestation of malnutrition and/or cardiovascular disease in chronic hemodialysis patients. Target DBP levels may be higher levels in chronic hemodialysis patients than the general population.
在之前的一份报告中，我们指出营养状况尤其是血清白蛋白对慢性血液透析患者的死亡具有很大的预测价值，而血压则不然。在本研究中，我们结合血清白蛋白与血压之间的关系分析了死亡原因。对1991年1月正在接受血液透析的1243名冲绳患者（719名男性，524名女性）进行随访直至1995年底。其中342名患者死亡，45名接受了移植，12名在随访期结束时转院。观察总时长为5110.3患者年。于1991年1月首次透析前即刻测定血压以及临床和实验室变量。舒张压（DBP）<70mmHg时粗死亡率为40.0%，70至79mmHg时为35.0%，80至89mmHg时为25.0%，90至99mmHg时为25.0%，>100mmHg时为13.0%。死亡率与舒张压呈负相关。舒张压与血清白蛋白呈显著正相关（r = 0.137，P < 0.001），与年龄呈负相关（r = -0.325，P < 0.0001）。当参考舒张压低于69mmHg时，舒张压每升高10mmHg，死亡的校正比值比（95%置信区间）为0.84（0.71至0.99）。低舒张压可能是慢性血液透析患者营养不良和/或心血管疾病的一种表现。慢性血液透析患者的目标舒张压水平可能高于普通人群。
