Long term reduction of cardiovascular risk factors associated with three hour daily dialysis: A prospective, cohort study.
Long term reduction of cardiovascular risk factors associated with three hour daily dialysis: A prospective, cohort study.
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与每日三小时透析相关的心血管危险因素的长期减少：一项前瞻性队列研究。
DOI：
10.1111/hdi.13096
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Ayus,JuanCarlos
中科院分区：
文献类型：
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作者：
Achinger,StevenG;Ayus,JuanCarlos
引言与常规血液透析（CHD）相比，每日血液透析（DHD）在1年随访时可改善左心室肥大和矿物质代谢。然而，有没有信息从前瞻性研究的长期影响DHD对这些关键的心血管危险factors.MethodsWe进行了一项为期4年的前瞻性队列研究，26 DHD和51匹配的冠心病患者的影响DHD（6次/周× 3小时）与冠心病（3次/周× 4小时），15 DHD，26冠心病患者完成了4年的随访。测量左心室质量指数（LVMI）、血压、血红蛋白和矿物质代谢标志物。结果在4年随访时，DHD组的收缩压和舒张压显著低于CHD组，为128 mmHg（95% CI，111-143）对比148 mmHg（95% CI，137-158）（p< 0.05）和60 mmHg（95% CI，56-63）对比71 mmHg（95% CI，64-76）（p< 0.05）。与CHD相比，DHD与接受任何降压药物治疗的患者较少，分别为50%和80%（p< 0.05）。与CHD相比，DHD与4年随访时磷（校正HR 3.6，p = 0.002）和钙磷乘积（校正HR 3.66，p = 0.001）的矿物质代谢目标的实现改善相关。4年时，DHD组LVMI低于CHD组的趋势不显著：116 g/m2（95% CI，97-136）vs 138 g/m2（95% CI，115-172）（p= 0.23）。同样，改善血红蛋白也持续4年follow-up.ConclusionDHD是与长期（4年）改善的关键心血管危险因素：血压，矿物质代谢，贫血与改善LVMI的趋势。
IntroductionDaily hemodialysis (DHD) compared to conventional hemodialysis (CHD) leads to improvements in left ventricular hypertrophy and mineral metabolism at 1‐year follow‐up. However, there is no information from prospective studies on the long terms effects of DHD on these key cardiovascular risk factors.MethodsWe conducted a 4 year, prospective cohort study of 26 DHD and 51 matched CHD patients on the effect of DHD (six sessions/week × 3 h) versus CHD (three sessions/week × 4 h), 15 DHD, and 26 CHD patients completed 4‐years follow‐up. Measures of left ventricular mass index (LVMI), blood pressures, hemoglobin, and mineral metabolism markers were performed.ResultsSystolic and diastolic blood pressures were significantly lower in the DHD group than the CHD group at 4‐year follow‐up, 128 mmHg (95% CI, 111–143) versus 148 mmHg (95% CI, 137–158) (p< 0.05) and 60 mmHg (95% CI, 56–63) versus 71 mmHg (95% CI, 64–76) (p< 0.05). DHD was associated with fewer patients taking any anti‐hypertensive drug therapy than CHD, 50% versus 80% (p< 0.05). DHD was associated with improved attainment of mineral metabolism goals for phosphorus (adjusted HR 3.6,p= 0.002) and calcium × phosphorus product (adjusted HR 3.66,p= 0.001) at 4‐years follow‐up compared to CHD. At 4 years, there was a nonsignificant trend toward lower LVMI in the DHD than in the CHD group: 116 g/m2(95% CI, 97–136) versus 138 g/m2(95% CI, 115–172) (p= 0.23). Similarly, improvements in hemoglobin also persisted at 4 years follow‐up.ConclusionDHD is associated with long‐term (4 year) improvements in key cardiovascular risk factors: blood pressure, mineral metabolism, and anemia with trends toward improved LVMI.