The associations between orthostatic blood pressure changes and extracellular volume in hemodialysis patients.
The associations between orthostatic blood pressure changes and extracellular volume in hemodialysis patients.
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DOI：
10.1111/hdi.12979
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Van Buren PN
中科院分区：
文献类型：
--
作者：
Jeon-Slaughter H;Gregg LP;Concepcion M;Lederer S;Penfield J;Van Buren PN
细胞外体积(ECV)可预测血液透析患者的死亡率，但在临床上难以评估。腹膜透析血压(BP)测量有助于ECV评估。临床上常规测量立位血压，但其与ECV的关系尚不清楚。在一组高血压血液透析患者中，我们用生物阻抗谱测量了血液透析后的ECV/体重，并分析了其与常规护理中HD后的立位血压测量的相关性。使用线性和Logistic回归，主要结果是立位血压改变和直立性低血压(OH)，定义为收缩压下降至少20毫米汞或舒张压下降至少10毫米汞。模型1控制了性别、年龄、糖尿病。模型2还对超滤率和降压药物进行了控制。我们进行了敏感性分析，使用OH定义的收缩压下降至少30毫米汞柱。57名受试者的平均立位收缩压变化为−7.3 mm Hg，平均ECV值为0.24(0.04)L/kg。HD后ECV/体重与立位收缩压变化无关(β=8.2p=0.6)。有16名有OH的参与者和41名没有OH的参与者。两组间ECV/体重差异无统计学意义(0.22[0.04]vs.0.24[0.05]L/kg，p=0.09)，在Logistic回归分析中也未预测OH(OR11，4.04；两种模型中95%可信区间2-671，0.03-530)。在敏感性分析中，OH组的ECV/体重较低(0.22vs.0.25[0.04]L/kg，p=0.005)，但这伴随着性别和糖尿病的差异。Logistic回归分析显示，ECV/体重与OH之间没有独立的相关性。HD完成后立位收缩压变化不是血液透析后ECV的可靠指标。当考虑与立位血压相关的其他因素时，ECV/体重并不独立地与OH相关。尽管透析后短暂的血管内容量差异可能与OH有关，但血液透析后的OH并不一定意味着ECV衰竭。
Extracellular volume (ECV) predicts mortality in hemodialysis patients, but it is difficult to assess clinically. Peridialytic blood pressure (BP) measurements can help ECV assessment. Orthostatic BP is routinely measured clinically, but its association with ECV is unknown. In a cohort of hypertensive hemodialysis patients, we measured post-hemodialysis ECV/weight with bioimpedance spectroscopy and analyzed its association with post-HD orthostatic BP measurements obtained during routine care. Using linear and logistic regression, the primary outcomes were orthostatic BP change and orthostatic hypotension (OH) defined by systolic BP decrease of at least 20 mmHg or diastolic decrease of at least 10 mmHg. Model 1 controlled for sex, age, diabetes. Model 2 additionally controlled for ultrafiltration rate and antihypertensive medications. We conducted sensitivity analysis using OH definition of systolic BP decrease of at least 30 mmHg. Among 57 participants, mean orthostatic systolic BP change was −7.30 mmHg and mean ECV/weight was 0.24 (0.04) L/kg. Post-HD ECV/weight was not associated with orthostatic systolic BP change (β=8.2, p=.6). There were 16 participants with and 41 participants without OH. The ECV/weight did not differ between these groups (0.22 [0.04] vs. 0.24 [0.05] L/Kg, p=.09) and did not predict OH in logistic regression (OR 11, 4.04; 95% CI .2–671, .03–530 in the 2 models.) In a sensitivity analysis, ECV/weight was lower in the OH group (0.22 [0.03] vs. 0.25 [0.04] L/kg, p=0.005), but this was accompanied by differences in sex and diabetes. Using logistic regression, there was no independent association between ECV/weight with OH. Orthostatic systolic BP change after HD completion is not a reliable indicator of post-hemodialysis ECV. When considering other factors associated with orthostatic BP, ECV/weight is not independently associated with OH. Although transient post-dialytic differences in intravascular volume may be associated with OH, post-hemodialysis OH does not necessarily indicate ECV depletion.
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