Risk of Intradialytic Hypotension by Day of the Week in Maintenance Hemodialysis.
Risk of Intradialytic Hypotension by Day of the Week in Maintenance Hemodialysis.
复制标题
维持性血液透析中每周各天的透析中低血压风险。
DOI：
10.1097/mat.0000000000001576
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发表时间：
2022-06-01
期刊：
影响因子：
4.2
通讯作者：
Mc Causland, Finnian R.
中科院分区：
文献类型：
--
作者：
Correa, Simon;Guerra-Torres, Xavier E.;Ravi, Katherine Scovner;Mothi, Suraj S.;Waikar, Sushrut S.;Mc Causland, Finnian R.
透析中低血压 (IDH) 是血液透析 (HD) 的常见并发症，与心血管 (CV) 事件和死亡风险较高相关。心血管事件在 HD 期间更为常见，尤其是在较长的透析间期之后。我们根据血液透析 (HEMO) 研究（N = 1,837 名患者；n = 64,474 次治疗）和 DaVita 临床研究生物样本库 [BioReG]）（N = 952 名患者；n = 61,197 次治疗）中接受每周三次中心 HD 的成人的 IDH 风险进行了调查。随机效应 Logistic 回归模型根据 HD 日（周一/周二 [HD1]；周三/周四 [HD2]；周五/周六 [HD3]）评估 IDH 风险（如果 HD 前 SBP <160 mm Hg，则定义为 HD 内收缩压最低点 [SBP] <90 mm Hg；如果 HD 前 SBP ≥160 mm Hg，则定义为 <100 mm Hg [Nadir90/100 定义]）。探讨了 IDH 的替代定义。 Nadir90/100 发生在 14% 的 HEMO 和 18% 的 BioReG 会话中。对于两个队列中的所有 IDH 定义，与 HD1 相比，HD2 和 HD3 的 IDH 风险单调增加。与 HD1 相比，HD2 与 HEMO 中 Nadir90/100 风险高出 10%（调整后比值比，1.10；95% CI，1.03-1.17）相关，HD3 与 HEMO 中高出 31% 风险（调整后比值比，1.31；95% CI，1.19-1.45）相关，这与 BioReG 中的结果一致。我们观察到，在两个不同的队列中，IDH 风险随着透析周后期的几天而单调增加。需要进一步研究以确定其潜在机制，以指导 IDH 预防策略。
Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of HD, especially following the longer interdialytic interval. We investigated the risk of IDH according to day of HD in adults undergoing in-center, thrice-weekly HD in the Hemodialysis (HEMO) Study (N = 1,837 patients; n = 64,474 sessions), and the DaVita Clinical Research biorepository [BioReG]) (N = 952 patients; n = 61,197 sessions). Random effects logistic regression models assessed the risk of IDH (defined as nadir intra-HD systolic blood pressure [SBP] <90 mm Hg if pre-HD SBP <160 mm Hg, or <100 mm Hg if pre-HD SBP ≥160 mm Hg [Nadir90/100 definition]) according to HD day (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]). Alternative definitions of IDH were explored. Nadir90/100 occurred in 14% of HEMO and 18% of BioReG sessions. A monotonic increase in the risk of IDH was observed for HD2 and HD3, compared with HD1, for all IDH definitions in both cohorts. Compared with HD1, HD2 was associated with a 10% higher risk of Nadir90/100 (adjusted odds ratio, 1.10; 95% CI, 1.03–1.17) and HD3 was associated with a 31% higher risk (adjusted odds ratio, 1.31; 95% CI, 1.19–1.45) in HEMO, with consistent results in BioReG. We observed a monotonic increased risk of IDH with later days of the dialytic week in two separate cohorts. Further research to determine the underlying mechanisms is necessary to guide strategies for IDH prevention.