Intradialytic Hypotension and Vascular Access Thrombosis
Intradialytic Hypotension and Vascular Access Thrombosis
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DOI：
10.1681/asn.2010101119
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发表时间：
2011-08-01
影响因子：
13.6
通讯作者：
Chertow, Glenn M.
中科院分区：
文献类型：
--
作者：
Chang, Tara I.;Paik, Jane;Chertow, Glenn M.
确定潜在的可改变的危险因素，以减少血液透析中血管通路血栓形成的发生率，可以减少相当大的发病率和医疗保健费用。我们分析了1426例HEMO研究受试者的数据，以确定更频繁的透析中低血压和/或更低的透析前收缩压是否与血管通路血栓形成的发生率更高相关。我们的主要结局指标是HEMO研究随访期间给定6个月内发生的血管通路血栓形成事件。在中位3.1年的随访期间，共有2005例血管通路血栓形成。透析中低血压的最高四分位数的自体动静脉内瘘血栓形成的相对发生率约为最低四分位数的两倍，与透析前收缩压和其他协变量无关。多变量校正后，透析中低血压与人工动静脉移植物血栓形成无显著相关性。较高的透析前收缩压与较低的瘘和移植物血栓形成率相关，独立于透析中低血压和其他协变量。总之，更频繁的透析中低血压和较低的透析前收缩压与血管通路血栓形成的发生率增加有关。这些结果强调了在血液透析中血压管理的未来研究中包括血管通路通畅性的重要性。
Identifying potential modifiable risk factors to reduce the incidence of vascular access thrombosis in hemodialysis could reduce considerable morbidity and health care costs. We analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and/or lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. Our primary outcome measure was episodes of vascular access thrombosis occurring within a given 6-month period during HEMO study follow-up. There were 2005 total episodes of vascular access thrombosis during a median 3.1 years of follow-up. The relative rate of thrombosis of native arteriovenous fistulas for the highest quartile of intradialytic hypotension was approximately twice that of the lowest quartile, independent of predialysis systolic BP and other covariates. There was no significant association of intradialytic hypotension with prosthetic arteriovenous graft thrombosis after multivariable adjustment. Higher predialysis systolic BP was associated with a lower rate of fistula and graft thrombosis, independent of intradialytic hypotension and other covariates. In conclusion, more frequent episodes of intradialytic hypotension and lower predialysis systolic BP associate with increased rates of vascular access thrombosis. These results underscore the importance of including vascular access patency in future studies of BP management in hemodialysis.