Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics
Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics
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DOI：
10.1038/ki.2010.315
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发表时间：
2011-01-01
影响因子：
19.6
通讯作者：
Middleton, John P.
中科院分区：
文献类型：
--
作者：
Pun, Patrick H.;Lehrich, Ruediger W.;Middleton, John P.
心脏骤停是维持血液透析的终末期肾病（HIM）患者最常见的死亡原因。在这里，我们试图通过一项病例对照研究来确定与这种风险增加相关的透析相关因素，该研究包括在一家大型组织的门诊诊所透析的43,200例患者。在这一组中，我们比较了502例心脏骤停患者的临床和透析特异性数据与1632例年龄和透析年龄匹配的对照。在3年的研究期间，每100,000例透析治疗中有4.5例心脏骤停事件。这些患者更有可能暴露于低于2 meq/l的低钾透析液。这些差异不能用透析前血清钾水平来解释。即使在透析前血清钾水平较高的患者中，也没有证据表明低钾透析液的有益作用。通过多变量分析，其他与心脏骤停密切相关的因素包括超滤容量增加、低钙透析液暴露和透析前血清肌酐水平。在调整协变量后，这些关系仍然存在，但传统的危险因素，如冠心病史和充血性心力衰竭没有显著影响。因此，我们的研究表明，血液透析处方的修改可能会提高ESKD患者心脏骤停的风险。国际肾脏杂志（2011）79,218-227；doi: 10.1038 / ki.2010.315;2010年9月1日在线发布
Sudden cardiac arrest is the most common cause of death among patients with end-stage kidney disease (HIM) maintained on hemodialysis. Here we sought to identify dialysis-related factors associated with this increased risk in a case-control study encompassing 43,200 patients dialyzed in outpatient clinics of a large organization. Within this group, we compared the clinical and dialysis-specific data of 502 patients who experienced a sudden cardiac arrest with 1632 age- and dialysis-vintage-matched controls. There were 4.5 sudden cardiac arrest events per 100,000 dialysis treatments during the 3-year study period. These patients were significantly more likely to have been exposed to low potassium dialysate of less than 2 meq/l. These differences could not be explained by predialysis serum potassium levels. There was no evidence for a beneficial effect of low potassium dialysate even among those with higher predialysis serum potassium levels. Other factors strongly associated with sudden cardiac arrest by multivariable analysis included increased ultrafiltration volumes, exposure to low calcium dialysate, and predialysis serum creatinine levels. These relationships persisted after adjustment for covariates, but traditional risk factors such as history of coronary heart disease and congestive heart failure were not significantly influential. Hence, our study suggests that modifications of the hemodialysis prescription may improve the risk of sudden cardiac arrest in patients with ESKD. Kidney International (2011) 79, 218-227; doi:10.1038/ki.2010.315; published online 1 September 2010