Association of segmental wall motion abnormalities occurring during hemodialysis with post-dialysis fatigue
Association of segmental wall motion abnormalities occurring during hemodialysis with post-dialysis fatigue
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DOI：
10.1093/ndt/gft097
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发表时间：
2013-10-01
影响因子：
6.1
通讯作者：
Johansen, Kirsten L.
中科院分区：
文献类型：
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作者：
Dubin, Ruth F.;Teerlink, John R.;Johansen, Kirsten L.
透析后疲劳（PDF）是一种常见的使人衰弱的症状，目前仍知之甚少。心脏室壁运动异常（WMA）可能会在透析过程中恶化，但它是未知的WMA是否与PDF.40例患者从加州大学附属透析单位2010年1月至2011年2月招募。参与者在79次透析之前和最后一小时接受了超声心动图检查。由一位不知情的评审员对心肌节段进行14级评分，其中4个代表最差WMA，并对每个超声心动图的节段评分进行求和。患者完成了关于其症状的问卷调查。重度PDF（定义为透析后持续2小时）采用广义线性模型进行分析，候选预测因子包括贫血、透析中血流动力学和心功能。44%的WMA恶化患者（n 9）患有重度PDF，而WMA改善或无变化的患者为13例（P 0.04）。透析期间WMA评分增加1分与重度PDF的RR增加10相关[RR：1.1，95 CI（1.1，1.2），P 0.001]。多变量校正后，WMA评分每增加1分，重度PDF风险增加2倍[RR：1.9，95 CI（1.4，2.6），P 0.001]。在调整人口统计学和合并症后，抑郁症史与重度PDF相关[RR：3.4，95 CI（1.3，9），P 0.01]，但贫血、血流动力学和其他心功能参数与重度PDF无关。尽管具有代表性，但这些结果表明，一些患者可能会在透析期间发生重度PDF作为心脏缺血的症状。
Post-dialysis fatigue (PDF) is a common, debilitating symptom that remains poorly understood. Cardiac wall motion abnormalities (WMAs) may worsen during dialysis, but it is unknown whether WMA are associated with PDF.Forty patients were recruited from University of California San Francisco-affiliated dialysis units between January 2010 and February 2011. Participants underwent echocardiograms before and during the last hour of 79 dialysis sessions. Myocardial segments were graded 14 by a blinded reviewer, with four representing the worst WMA, and the segmental scores were summed for each echocardiogram. Patients completed questionnaires about their symptoms. Severe PDF (defined as lasting 2 h after dialysis) was analysed using a generalized linear model with candidate predictors including anemia, intradialytic hemodynamics and cardiac function.Forty-four percent of patients with worsened WMA (n9) had severe PDF, compared with 13 of patients with improved or unchanged WMA (P 0.04). A one-point increase in the WMA score during dialysis was associated with a 10 higher RR of severe PDF [RR: 1.1, 95 CI (1.1, 1.2), P 0.001]. After multivariable adjustment, every point increase in the WMA score was associated with a 2-fold higher risk of severe PDF [RR: 1.9, 95 CI (1.4, 2.6), P 0.001]. History of depression was associated with severe PDF after adjustment for demographics and comorbidities [RR: 3.4, 95 CI (1.3, 9), P 0.01], but anemia, hemodynamics and other parameters of cardiac function were not.Although cross-sectional, these results suggest that some patients may experience severe PDF as a symptom of cardiac ischemia occurring during dialysis.