Predialysis serum phosphate and intradialytic hypotension.
Predialysis serum phosphate and intradialytic hypotension.
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透析前血清磷酸盐和透析中低血压。
DOI：
10.1111/hdi.12971
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
McCausland,FinnianR
中科院分区：
文献类型：
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作者：
Ravi,KatherineScovner;Reeves,PatrickB;Correa,Simon;Neves,JoãoSérgio;Waikar,SushrutS;Mothi,SurajS;McCausland,FinnianR
透析中低血压(IDH)是血液透析(HD)的常见并发症，与高发病率和高死亡率有关。在维持性血液透析患者中，较高的血磷水平与心血管不良结局相关；然而，其与IDH的相关性尚未被评估。方法这是一项对在大型透析组织(LDO)接受HD治疗的969名HD患者(80,968次)的前瞻性队列分析，以及对1838名HD患者(10,594次HD)的事后分析，HEMO是一项多中心随机对照试验，检查了标准或大剂量HD以及低通量或高通量膜。未调整和调整的混合效应回归模型适用于确定HD前血磷与IDH的相关性，IDH被定义为HD内最低收缩压和90 mm Hg.在LDO队列中，HD前血磷的基线平均值为5.2 ± 1.7m g/dl。15.6%的HD患者出现IDH。在调整后的模型中，较高的透析前血磷(每1 mg/dl)与IDH风险增加12%相关(AOR1.12，95%CI1.10-1.13，p<；0.001)。在有HD前化验值的探索性模型中，效应估计有所减弱，但仍具有统计学意义(AOR 1.05；95%CI 1.02-1.08；p<；0.01)。在调整后的模型中，透析前血磷水平最高(与最低)四分位数的参与者IDH的风险增加56%(AORQ4：Q11.56；95%CI1.44-1.68，p<；0.001)。在血液数据中，高磷酸盐与IDH的相关性是一致的。讨论HD前高血磷与IDH风险增加独立相关。由于HD可能会导致血磷的急剧下降，未来有必要进行研究以探讨这种联系的机制。
IntroductionIntradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with excess morbidity and mortality. Higher serum phosphate is associated with adverse cardiovascular outcomes in maintenance HD patients; however, its association with IDH has not previously been assessed.MethodsThis is an analysis of a prospective cohort of 969 HD patients (80,968 HD sessions) receiving HD at a large dialysis organization (LDO) and a post‐hoc analysis of 1838 HD patients (10,594 HD sessions) in the Hemodialysis study (HEMO), a multicenter randomized controlled trial that examined standard or high‐dose HD and low‐flux or high‐flux membranes. Unadjusted and adjusted mixed effects regression models were fit to determine the association of pre‐HD serum phosphate with IDH, defined as a nadir intra‐HD systolic blood pressure (SBP) <90 mmHg.FindingsIn the LDO cohort, baseline mean pre‐HD serum phosphate was 5.2 ± 1.7 mg/dl. IDH occurred in 15.6% of HD sessions. In the adjusted model, higher pre‐HD serum phosphate (per 1 mg/dl) was associated with a 12% increased risk of IDH (aOR 1.12, 95% CI 1.10–1.13,p<0.001). In exploratory models where pre‐HD laboratory values were available, the effect estimate was attenuated but remained statistically significant (aOR 1.05; 95% CI 1.02–1.08;p<0.01). Participants in the highest (compared with the lowest) quartile of pre‐HD serum phosphate had a 56% greater risk of IDH in the adjusted model (aOR Q4:Q1 1.56; 95% CI 1.44–1.68,p<0.001). The association of higher phosphate with IDH was consistent in the HEMO data.DiscussionHigher pre‐HD serum phosphate is independently associated with an increased risk of IDH. As HD may cause an acute decline in serum phosphate, future studies to investigate the mechanisms of this association are warranted.