Coomer R W, Schulman G, Breyer J A, Shyr Y
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Am J Kidney Dis. 1997 May;29(5):678-84. doi: 10.1016/s0272-6386(97)90119-0.
To define blood pressure (BP) patterns and control in dialysis patients, 48-hour ambulatory BP monitoring was performed in 36 hemodialysis and 18 peritoneal dialysis patients. Monitoring began during a dialysis session for hemodialysis patients. Data revealed significantly lower diastolic BP (DBP) and lower diastolic load (percentage of diastolic values > 90 mm Hg) in hemodialysis patients compared with peritoneal dialysis patients (80.6 mm Hg v 88.8 mm Hg, respectively, [P < 0.03] and 26% v 45%, respectively [P < 0.03]) for the 48-hour period. When the 2 days were analyzed separately, the difference in diastolic pressures and loads was significant only for the first (dialysis) day. Similarly, trends toward lower systolic BP (SBP) and systolic load in hemodialysis patients existed throughout monitoring and were greater in magnitude during the first day. BP data were fit to a random-coefficient growth curve model to detect periodicity. This sensitive model did not detect diurnal variation of BP in either group. The incidence of hypotension did not differ between the two groups (2.0% v 1.0% of total observations, hemodialysis v peritoneal dialysis). In the hemodialysis group, the proportion of hypotensive observations was significantly greater during the 4 hours postdialysis compared with other periods (5.6% v 1.6%; P < 0.02), a finding that likely reflects the practice of holding antihypertensives until after hemodialysis. However, patient diaries did not reflect hypotensive symptoms during this time. In the hemodialysis group, mean BP and predialysis BP did not correlate with interdialytic sodium load or weight gain. Predialysis and postdialysis BP (recorded by dialysis nurses) correlated significantly with mean BP. Predialysis SBP overestimated mean SBP by an average of 10 mm Hg, while postdialysis SBP underestimated mean SBP by an average of 7 mm Hg. To create formulas to estimate mean SBP and DBP in hemodialysis patients, multiple linear regression was used to model these variables against age, sex, race, and average prehemodialysis/posthemodialysis BP. The model achieved a high degree of fit (r2 = 0.72 for SBP; r2 = 0.65 for DBP), demonstrating that prehemodialysis and posthemodialysis BP can be used to predict mean BP in hemodialysis patients. In summary, our data show the absence of a diurnal variation of BP in dialysis patients and lower BP in hemodialysis patients compared with peritoneal dialysis patients. Among hemodialysis patients, more hypotension occurred after dialysis compared with other periods, and predialysis and postdialysis BP can be used to model mean BP levels.
为了明确透析患者的血压（BP）模式及控制情况，对36例血液透析患者和18例腹膜透析患者进行了48小时动态血压监测。血液透析患者的监测在透析期间开始。数据显示，在48小时期间，与腹膜透析患者相比，血液透析患者的舒张压（DBP）显著更低，舒张压负荷（舒张压值>90 mmHg的百分比）也更低（分别为80.6 mmHg对88.8 mmHg，[P<0.03]；分别为26%对45%，[P<0.03]）。当分别分析这两天时，仅在第一天（透析日）舒张压和负荷的差异具有统计学意义。同样，在整个监测过程中，血液透析患者的收缩压（SBP）和收缩压负荷有降低趋势，且在第一天幅度更大。将血压数据拟合到随机系数生长曲线模型以检测周期性。该敏感模型未检测到两组患者血压的昼夜变化。两组患者低血压的发生率无差异（血液透析组与腹膜透析组分别占总观察次数的2.0%对1.0%）。在血液透析组，透析后4小时内低血压观察的比例显著高于其他时间段（5.6%对1.6%；P<0.02），这一发现可能反映了在血液透析后才停用降压药的做法。然而，患者日记并未反映这段时间的低血压症状。在血液透析组，平均血压和透析前血压与透析间期钠负荷或体重增加无关。透析前和透析后血压（由透析护士记录）与平均血压显著相关。透析前收缩压平均高估平均收缩压10 mmHg，而透析后收缩压平均低估平均收缩压7 mmHg。为了创建估算血液透析患者平均收缩压和舒张压的公式，采用多元线性回归将这些变量与年龄、性别、种族以及透析前/透析后平均血压进行建模。该模型拟合度很高（收缩压的r2 = 0.72；舒张压的r2 = 0.65），表明透析前和透析后血压可用于预测血液透析患者的平均血压。总之，我们的数据表明透析患者不存在血压昼夜变化，且血液透析患者的血压低于腹膜透析患者。在血液透析患者中，透析后比其他时间段发生更多低血压，且透析前和透析后血压可用于构建平均血压水平模型。
