Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study
Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study
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透析中血压下降的季节变化和预测因素：一项回顾性队列研究
DOI：
10.1038/s41440-021-00714-1
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发表时间：
2021
影响因子：
5.4
通讯作者：
Itoh Hiroshi
中科院分区：
文献类型：
--
作者：
Uchiyama Kiyotaka;Shibagaki Keigo;Yanai Akane;Kusahana Ei;Nakayama Takashin;Morimoto Kohkichi;Washida Naoki;Itoh Hiroshi
分析期收缩压下降的危险因素仍然知之甚少。考虑到收缩压的季节性变化，我们的目的是确定临床和实验室预测指标。在一项回顾性队列研究中，共有307名患者在三家透析诊所接受了一年以上的血液透析，共47,219次血液透析，分析中收缩压下降（透析前收缩压-最低收缩压）的季节变化和预测因素分别使用余弦分析和线性混合模型对基线或月度血液透析相关变量进行了调整。冬、夏两季患者血凝期收缩压下降幅度最大、最小，具有明显的季节性。在基线和每月血液透析相关参数调整后的两个模型中，钙通道阻滞剂的使用与较小的下降相关(- 4.58[95%可信区间（CI）， - 5.84至- 3.33]，P< 0.001；−3.66 [95% CI,−5.69 ~−1.64]，P< 0.001)和α受体阻滞剂的使用，下降幅度更大（3.25 [95% CI, 1.53 ~ 4.97]，P< 0.001; 3.57 [95% CI, 1.08 ~ 6.06]，P= 0.005）。基线和月血清磷水平与下降呈正相关（1.55 [95% CI, 0.30-2.80]，P= 0.02; 0.59 [95% CI, 0.16-1.00]，P= 0.007），基线和月标准化蛋白质分解代谢率呈负相关（分别为- 22.41 [95% CI, - 33.53 ~ - 11.28]，P< 0.001; 9.65 [95% CI, 4.60-14.70]，P< 0.001）。综上所述，钙通道阻滞剂的使用、α受体阻滞剂的避免和血清降磷治疗可能会减轻血凝期收缩压下降，应该在前瞻性试验中进行研究。
The risk factors for intradialytic systolic blood pressure decline remain poorly understood. We aimed to identify clinical and laboratory predictors of the intradialytic systolic blood pressure decline, considering its seasonal variation. In a retrospective cohort of 47,219 hemodialysis sessions of 307 patients undergoing hemodialysis over one year in three dialysis clinics, the seasonal variation and the predictors of intradialytic systolic blood pressure decline (predialysis systolic blood pressure––nadir intradialytic systolic blood pressure) were assessed using cosinor analysis and linear mixed models adjusted for baseline or monthly hemodialysis-related variables, respectively. The intradialytic systolic blood pressure decline was greatest and least in the winter and summer, respectively, showing a clear seasonal pattern. In both models adjusted for baseline and monthly hemodialysis-related parameters, calcium channel blocker use was associated with a smaller decline (−4.58 [95% confidence interval (CI), −5.84 to −3.33],P< 0.001; −3.66 [95% CI, −5.69 to −1.64],P< 0.001) and α blocker use, with a greater decline (3.25 [95% CI, 1.53–4.97],P< 0.001; 3.57 [95% CI, 1.08–6.06],P= 0.005). Baseline and monthly serum phosphorus levels were positively correlated with the decline (1.55 [95% CI, 0.30–2.80],P= 0.02; 0.59 [95% CI, 0.16–1.00],P= 0.007), and baseline and monthly normalized protein catabolic rates were inversely correlated (respectively, −22.41 [95% CI, −33.53 to −11.28],P< 0.001; 9.65 [95% CI, 4.60–14.70],P< 0.001). In conclusion, calcium channel blocker use, α blocker avoidance, and serum phosphorus-lowering therapy may attenuate the intradialytic systolic blood pressure decline and should be investigated in prospective trials.