Intradialytic Hypotension: Mortality, Cardiovascular Outcomes & Magnesium's Role

描述（由申请人提供）：血液透析患者的心血管发病率和死亡率比一般人群高10 - 30倍，超过了基于传统风险因素的预期。透析中低血压非常普遍，是一种潜在的可改变因素，可能通过在冠状动脉循环中造成供需不匹配、中断终末器官灌注和影响透析期间液体和毒素的充分清除而导致心血管疾病负担。本研究将检查透析中低血压的频率和严重程度与全因死亡率以及心血管死亡率和发病率之间的相关性。全因死亡率将在一个大型的全国性透析患者队列中进行检查，以确保广泛的普遍性。将使用血液透析（HEMO）研究的数据检查心血管终点，因为判定死亡和住院事件的归因是严格和标准化的过程。此外，本研究将检查血清镁水平对透析中低血压频率和严重程度的影响，作为一种潜在的治疗干预手段。成功完成后，本研究将提供证据，证明血液透析患者的心血管健康和生存率是否可以通过有针对性地降低透析中低血压来改善。此外，这些数据将提供关于透析中低血压可能被操纵的潜在方法的见解。这些发现对这一高度脆弱人群的临床护理具有重大而直接的影响，也将为未来的调查提供素材。 公共卫生相关性：仅在美国就有超过350，000名终末期肾衰竭患者接受长期血液透析，与一般人群相比，血液透析患者的心血管发病率和死亡率高出10至30倍，超过了基于传统风险因素的预期。透析中低血压发生在所有透析治疗的15%至25%之间，是一种可能导致死亡率和心血管疾病负担的潜在可变因素，血清镁失衡是一种潜在原因。

DESCRIPTION (provided by applicant): Rates of cardiovascular morbidity and mortality are between 10 and 30-fold higher among hemodialysis patients as compared to the general population, and exceed that which is expected on the basis of traditional risk factors. Intra-dialytic hypotension is highly prevalent and a potentially modifiable factor that may contribute to the burden of cardiovascular disease by creating supply-demand mismatch in the coronary circulation, interrupting end organ perfusion and compromising adequate removal of fluid and toxins during dialysis. This study will examine the association between the frequency and severity of intra-dialytic hypotension and all-cause mortality, and cardiovascular mortality and morbidity. All-cause mortality will be examined in a large, national cohort of prevalent dialysis patients to ensure broad generalizability. Cardiovascular endpoints will be examined using data from the Hemodialysis (HEMO) Study because of the rigorous and standardized process by which attribution of death and hospitalization events were adjudicated. In addition, the study will examine the effects of serum magnesium level on the frequency and severity of intra- dialytic hypotension, as one potential means of therapeutic intervention. Upon successful completion, this study will provide evidence as to whether cardiovascular health and survival among hemodialysis patients might be improved via targeted reductions in intra-dialytic hypotension. In addition, the data will offer insights as to potential means by which intra-dialytic hypotension might be manipulated. These findings hold great and immediate implications for clinical care of this highly vulnerable population, and will also provide fodder for future investigation. PUBLIC HEALTH RELEVANCE: Over 350,000 patients with end-stage renal failure are on chronic hemodialysis in the United States alone, and rates of cardiovascular morbidity and mortality are between 10 and 30-fold higher among hemodialysis patients as compared to the general population, exceeding that which is expected on the basis of traditional risk factors. Intra-dialytic hypotension occurs in between 15 and 25% of all dialysis treatments and is a potentially modifiable factor that may contribute to mortality and the burden of cardiovascular disease, with serum magnesium disequilibrium as a potentially cause.