Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients
Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients
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DOI：
10.1111/j.1523-1755.2004.00812.x
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发表时间：
2004-09-01
影响因子：
19.6
通讯作者：
Imai, E
中科院分区：
文献类型：
--
作者：
Shoji, T;Tsubakihara, Y;Imai, E
背景。血液透析患者血压（BP）与死亡率之间的关系一直存在争议。一些研究表明，较低的透析前或透析后血压与较高的死亡率有关，而另一些研究则显示高血压未控制的患者预后较差。我们进行了一项多中心前瞻性队列研究，以评估血液透析相关性低血压对死亡率的影响。我们招募了1244名患者（685名男性，平均年龄60 +/- 13岁），他们在1999年12月开始的两年研究期间在28个单位接受了血液透析。所有患者在入院时都测量了透析前、透析中、透析后的血压，以及血液透析后不久站立时的血压。采用Logistic回归分析来评估透析前、透析中和透析后血压、血液透析期间血压下降以及血液透析后站立后血压下降对死亡率的影响。在研究期间，149名患者死亡。Logistic模型发现，血液透析后站立时最低收缩压（SBP）和收缩压下降程度是影响死亡率的重要因素，但不影响透析前和透析后的收缩压和舒张压。校正后的死亡优势比为0.79 (95% CI 0.64-0.98)，最低收缩压以20 mm Hg的增量分析；校正后的死亡优势比为0.82 (95% CI 0.67-0.98)，血液透析后站立后收缩压以10 mm Hg的增量分析。以上结果提示，血液透析后透析内低血压和体位性低血压是影响血液透析患者死亡率的重要独立因素。
Background. The relationship between blood pressure (BP) and mortality in hemodialysis patients has remained controversial. Some studies suggested that a lower pre- or postdialysis BP was associated with excess mortality, while others showed poorer outcome in patients with uncontrolled hypertension. We conducted a multicenter prospective cohort study to evaluate the impact of hemodialysis-associated hypotension on mortality.Methods. We recruited 1244 patients (685 males; mean age, 60 +/- 13 years) who underwent hemodialysis in 28 units during the two-year study period beginning in December 1999. Pre-, intra-, and postdialysis BP, and BP upon standing soon after hemodialysis, were measured in all patients at entry. Logistic regression analysis was used to assess the effect on mortality of pre-, intra-, and postdialysis BP, a fall in BP during hemodialysis, and a fall in BP upon standing soon after hemodialysis.Results. During the study period, 149 patients died. Logistic models identified the lowest intradialysis systolic blood pressure (SBP) and degree of fall in SBP upon standing soon after hemodialysis as significant factors affecting mortality, but not pre- or postdialysis SBP and diastolic BP. The adjusted odds ratio for death was 0.79 (95% CI 0.64-0.98) when the lowest intradialysis SBP was analyzed in increments of 20 mm Hg, and was 0.82 (95% CI 0.67-0.98) when the fall in SBP upon standing soon after hemodialysis was analyzed in increments of 10 mm Hg.Conclusion. These results suggest that intradialysis hypotension and orthostatic hypotension after hemodialysis are significant and independent factors affecting mortality in hemodialysis patients.