A Model of Systolic Blood Pressure During the Course of Dialysis and Clinical Factors Associated With Various Blood Pressure Behaviors
A Model of Systolic Blood Pressure During the Course of Dialysis and Clinical Factors Associated With Various Blood Pressure Behaviors
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DOI：
10.1053/j.ajkd.2011.05.028
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发表时间：
2011-11-01
影响因子：
13.2
通讯作者：
Brunelli, Steven M.
中科院分区：
文献类型：
--
作者：
Dinesh, Kumar;Kunaparaju, Srikanth;Brunelli, Steven M.
背景：对血液透析期间收缩压 (SBP) 的行为知之甚少。研究设计：前瞻性观察队列。设置和参与者：218 名在 5 个参与 DaVita 透析中心接受治疗的常见血液透析患者。预测因素：可能影响血液透析过程中 SBP 行为的临床变量。结果：透析开始时的 SBP 及其变化率（斜率）治疗间隔的前 25% 和后 75%。测量：在研究的前 30 天期间按照临床方案测量和记录 SBP（中位数，每名患者 11 次治疗；每隔 30 分钟测量 SBP）。结果：透析中 SBP 行为通过 2 斜率线性样条模型得到很好的表征，该模型描述了零时的 SBP、治疗的前 25% 期间（早期）的快速下降以及更逐渐的下降此后（晚）。较高的超滤量和速率均与透析开始时较高的 SBP 以及早期和晚期 SBP 下降更快相关。使用较多数量的抗高血压药物与较大的零时收缩压相关。醋酸钙的使用与血液透析开始时的高收缩压有关，并且在治疗的早期和后期阶段收缩压更明显。局限性：黑人和充血性心力衰竭患者的比例过高；观察性设计；使用临床测量的血压。结论：透析中 SBP 可以使用 3 个参数来表征：透析开始时的值以及治疗前 25% 和后 75% 期间的斜率。与液体管理、抗高血压药物使用和代谢性骨病控制相关的实践与透析期间的血压行为相关。需要进一步的工作来证实研究结果并测量透析中血压行为各个方面与临床结果之间的关联。 Am J 肾病杂志。 58（5）：794-803。 (C) 2011 年，国家肾脏基金会 (National Kidney Foundation, Inc.)
Background: Little is known about the behavior of systolic blood pressure (SBP) during hemodialysis.Study Design: Prospective observational cohort.Setting & Participants: 218 prevalent hemodialysis patients treated at 5 participating DaVita Dialysis units.Predictors: Clinical variables that may plausibly influence the behavior of SBP during the course of hemodialysis sessions.Outcomes: SBP at the onset of dialysis and its rate of change (slope) over the first 25% and latter 75% of the treatment interval.Measurements: SBPs measured and recorded per clinical protocol during the first 30 days of study (median, 11 treatments/patient; SBP measured at 30-minute intervals).Results: Intradialytic SBP behavior is well characterized by a 2-slope linear spline model, which describes SBP at time zero, a rapid decrease during the first 25% of the treatment (early), and a more gradual decrease thereafter (late). Higher ultrafiltration volume and rate each are associated with greater SBP at the start of dialysis and more rapid early and late SBP decreases. Use of a higher number of antihypertensives was associated with greater time zero SBP. Calcium acetate use is associated with high SBP at the start of hemodialysis and a more pronounced decrease during the early and late parts of treatment.Limitations: Over-representation of blacks and patients with congestive heart failure; observational design; use of clinically measured blood pressures.Conclusions: Intradialytic SBP can be characterized using 3 parameters: value at the start of dialysis and slopes during the first 25% and latter 75% of treatment. Practices related to fluid management, antihypertensive use, and metabolic bone disease control are associated with blood pressure behavior during dialysis. Further work is needed to confirm findings and measure associations between various aspects of intradialytic blood pressure behavior and clinical outcomes. Am J Kidney Dis. 58(5):794-803. (C) 2011 by the National Kidney Foundation, Inc.