Clinical and prognostic analysis of pulmonary hypertension in maintenance hemodialysis patients

Objective To investigate the related factors and prognosis of pulmonary hypertension (PAH) in hemodialysis (HD) patients for early diagnosis and intervention of PAH. Methods A retrospective cohort study was conducted in 183 long?term hemodialysis patients with complete follow?up data from January 1, 2010 to December 30, 2015 from the blood purification center of the Third Affiliated Hospital of Sun Yat?sen University. The follow?up deadline was December 30, 2017, and the endpoints were death and cardiovascular events. The clinical data, laboratory examinations, cardiac color Doppler ultrasound parameters and prognosis of patients with and without PAH were compared. Multivariate logistic regression was used to analyze the risk factors for PAH in HD patients. The survival rates were calculated by Kaplan?Meier method, and the survival curves were compared by Log?rank test between the two groups. A multivariate Cox proportional hazard regression model was used to examine the association between PAH and all?cause mortality in HD patients. Results Of the 183 hemodialysis patients, 79(43.2%) were female, 104(56.8%) were male, and the age was (56.1±16.9) years, of which 72(39.3%) were complicated with PAH. Compared with the non?PAH group, patients in the PAH group was older and had a longer duration of dialysis (both P＜0.05). The left atrial diameter (P=0.002) and the proportion of valvular calcification (P=0.004) were significantly higher in the PAH group than that in the non?PAH group. Logistic regression analysis showed increased age (OR=1.027, 95% CI 1.001-1.053, P=0.041) and increased duration of dialysis (OR=1.129, 95% CI 1.004-1.269, P=0.042) were risk factors for PAH in HD patients. After a median follow?up of 27.8 months, Kaplan?Meier survival analysis showed that all?cause mortality was higher in the PAH group than that in the non?PAH group (χ2=5.636, P=0.018). The main cause of death in two groups was cardiovascular event. After adjusting for age, diabetes mellitus, duration of dialysis, valvular calcification, and hypertension, Cox regression showed that PAH increased the risk of all?cause mortality in HD patients (HR=1.894, 95% CI 1.083-3.313, P=0.025). Conclusions HD patients complicated with PAH are more common and the prognosis is poor. Increased age and increased duration of dialysis may be risk factors for PAH in HD patients. Regular color Doppler echocardiography is helpful for early detection and diagnosis of PAH.     

Comparison of blood pressure variability and rhythm between peritoneal dialysis patients and hemodialysis patients and the correlations with cardiovascular disease-related death

Objective To compare the differences of blood pressure variability (BPV) and blood pressure rhythm (BPR) between maintenance peritoneal dialysis (MPD) and maintenance hemodialysis (MHD) patients, and explore the relationship of BPV and BPR with cardiovascular disease (CVD)-related death. Methods This was a prospective cohort study. Patients with maintenance dialysis treatment for more than 3 months in the General Hospital of Ningxia Medical University and stable clinical status were recruited from December 2015 to July 2016. The patients' general data, biochemical indexes and dialysis-related indexes were collected. BPV and BPR were observed by ambulatory blood pressure monitoring in all patients. The prospective follow-up was up to February 2020. All patients were divided into high 24 h systolic blood pressure variability (24hSBPV) group and low 24hSBPV group based on the median of 24hSBPV, and the baseline data of the two groups were compared. The BPV and BPR between MPD and MHD patients were compared. Kaplan-Meier method was used for survival analysis. The relationship between BPV and CVD-related death was analyzed by Cox regression. Results A total of 120 dialysis patients were included in the study, including 76 males (63.33%). The age was (50.89±14.61) years old and the median dialysis age was 42(28, 58) months. There were 60 patients in the high 24hSBPV group and 60 patients in the low 24hSBPV group, and the differences in total Kt/V (urea clearance), calcium channel blocker and β-blockerrs between the two groups were statistically significant (all P＜0.05). There were no statistically significant differences in age, gender, primary disease, CVD, hemoglobin, blood calcium, blood phosphorus, estimated glomerular filtration rate, blood uric acid, intact parathyroid hormone, serum iron and so on between the two groups. 24hSBPV in MHD patients was significantly higher than that in MPD patients [(13.92±3.79) mmHg vs (12.49±3.99) mmHg, t=2.01, P=0.041]. The incidence of abnormal circadian rhythm of blood pressure in all patients was 93.33%(112/120), and non-dipper blood pressure accounted for 84.17%(101/120). There was no significant difference in BPR between the MPD and MHD patients. With follow-up of 42.00(14.25, 42.00) months, a total of 60 cases (50%) CVD events occurred, of which there were 31 cases (25.83%) CVD-related death. The multivariate Cox regression analysis showed that the high 24hSBPV was an independent influencing factor for CVD-related death in patients with MHD and MPD after the confounding factors (ages, sex, body mass index, serum creatinine, hemoglobin, uric acid, hypersensitivity C-reactive protein and so on) were corrected (HR=1.25, 95% CI 1.06-1.47, P=0.007; HR=1.24, 95%CI 1.09-1.40, P=0.001). Conclusions The 24hSBPV in MHD patients is higher than that in MPD patients. With the increase of 24hSBPV, the risk of CVD increases in patients with MHD and MPD. 24hSBPV is an independent influencing factor for CVD-related death in both MHD and MPD patients.     

Prognostic value of red cell distribution width in maintenance hemodialysis patients

Objective To investigate the relationship of red cell distribution width (RDW) with all-cause mortality and cardiovascular disease (CVD) mortality in patients undergoing maintenance hemodialysis (MHD). Methods A retrospective analysis was performed in patients who initiated MHD from January 2008 to September 2017 in the hemodialysis center of the Second Affiliated Hospital of Soochow University. Basic data on demographic, dialysis and laboratory were collected, and echocardiography indicators and clinical outcomes were recorded. Patients were divided into four groups according to the quartile of RDW level. Kaplan-Meier survival analysis was used to compare the difference of survival rate among the groups. Cox regression analysis was used to analyze the risk factors of all-cause and CVD-related mortality, and predictive value of RDW for all-cause and CVD-related death in hemodialysis patients. Results A total of 268 MHD patients were enrolled in this study with age of (60.9±15.8) years and dialysis duration of (58.1±9.1) months, including 159 males(59.3%). Kaplan-Meier survival analysis showed that the 1-year overall survival rates of Q1 group (RDW≤13.8%, n=61), Q2 group (RDW 13.9%-14.6%, n=66), Q3 group (RDW 14.7%-15.6%, n=73) and Q4 group (RDW≥15.7%, n=68) were 96.8%, 95.1%, 93.1% and 85.7% respectively; 3-year overall survival rates were 88.5%, 87.5%, 59.2% and 51.8% respectively; 5-year overall survival rates were 71.5%, 65.4%, 33.6% and 17.7% respectively; The difference between the groups was statistically significant (all P＜0.01). The 1-year CVD survival rates were 98.4%, 96.6%, 95.8% and 92.4% respectively; 3-year CVD survival rates were 94.8%, 92.5%, 84.4% and 70.4% respectively; 5-year CVD survival rates were 86.9%, 81.3%, 65.6% and 51.3% respectively; The difference between the groups was statistically significant (all P＜0.01). Multivariate Cox regression analysis showed that RDW≥15.7% was an independent risk factor for all-cause and CVD-related mortality in MHD patients. The risk of all-cause mortality in Q4 group was 3.098 times higher than that in Q1 group (95%CI 1.072-8.950, P=0.037) and the risk of CVD-related mortality was 2.661 times (95%CI 1.111-8.342, P=0.048). Receiver operating characteristic curve (ROC) showed that RDW=14.85% was the best cut-off point for predicting the all-cause mortality in HD patients (P＜0.01), RDW=15.45% was the best cut-off point for predicting the cardiovascular disease mortality (P＜0.01), and RDW=14.45% had a higher 5-year survival rate (P＜0.01). Conclusion RDW can independently predict all-cause and CVD-related mortality risk in hemodialysis patients, and it has important value for prognosis.     

Preliminary study on the intradialytic blood pressure variability and influencing factors

Objective To understand the blood pressure variability (BPV) and the influencing factors through ambulatory blood pressure monitoring during hemodialysis (HD) in the end-stage renal disease (ESRD) patients. Method Eighty-one ESRD patients on maintenancing HD for more than three months were enrolled into the study. The patients were with properly dry body weight. The blood pressure was monitored using dynamic blood pressure monitor around the HD.BPV was estimated with the coefficient of variation (CV) and standard deviation (SD) of the systolic blood pressure (SBP-CV, SBP-SD). Patients were divided into two groups according to the mean of SBP-CV: high SBPV group and low SBPV group. The possible influencing factors such as age, dialysis duration, ultrafiltration volume, ultrafiltration/body weight, therapy of antihypertensive, electrolyte, nutrition state, metabolic bone disease indexes, inflammatory state and serum lipid state were analyzed and compared between the two groups. And multivariate stepwise regression analysis was made between the SBP-CV, SBP-SD and the above observational parameters. Results The average SBP-CV of the 81 patients was (8.12±3.16)%, SBP-SD was (11.22±4.55) mm Hg. The proportion of hypertention and hypotention in high SBPV(SBP-CV≥8.12%) group (20.0%, 25.7%) was higher than that in the low SBPV(SBP-CV＜8.12%) group (8.7%, 6.5%)(P＝0.009). Serum high-sensitivity c-reactive protein (hs-CRP) and alkaline phosphatase (ALP) were higher in high SBPV group than that in the low SBPV group[(7.19±5.95) mg/L vs (3.35±2.78) mg/L, P＝0.001 and (180.31±96.32) U/L vs (98.00±41.19) U/L, P＝0.049]. Serum creatinine and potassium were higher in the low SBPV group than that in the high SBPV group [(1015.83±276.20) μmol/L vs (893.63±216.61) μmol/L, P＝0.034 and (5.27±0.78) mmol/L vs (4.80±0.23) mmol/L, P＝0.005]. SBP-SD was positively correlated with hs-CRP (β＝0.499, P＜0.01), SBP-CV was positively correlated with hs-CRP and dialysis vintage (β＝0.464 and 0.211, P＜0.01 and P＜0.05) by the multivariate stepwise regression analysis. Conclusions The SBP-CV during HD is 8.12% in ESRD patients. Hypertention and hypotention are more often in the higher SBPV patients. SBPV is closely related to the serum hs-CRP.     

维持性血液透析患者心脏结构功能的危险因素分析

目的探讨影响维持性血液透析（MHD）患者心脏结构功能的危险因素。方法选择MHD患者153例,超声心动图测定心脏各项指标,并计算左心室心肌重量指数（LVMI）。生存函数乘积限（Kaplan-Meier）分析观察LVMI对患者预后的影响,分析影响LVMI的危险因素关系。结果153例MHD患者中,84例（占55．2％）患者存在左心室肥厚。多元回归结果显示超滤量（UF）和血红蛋白是影响左心室肥厚的独立危险因素。每周3次透析与每周2次透析的患者左心室肥厚的发生率分别为59．3％和52．1％。Kaplan-Meier生存分析显示左心室肥厚患者的5、10和15年生存率分为78．3％、54．3％和36．2％。结论MHD患者存在较高的左心室肥厚发生率,UF、血红蛋白与左心室肥厚相关,预防患者左心室肥厚可能有助于提高患者生存率。     

Prevalence and risk factors of sarcopenia in peritoneal dialysis patients

Objective To investigate the prevalence and risk factors of sarcopenia in peritoneal dialysis (PD) patients. Methods The patients who underwent regular peritoneal dialysis at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between November 2016 and March 2018 were enrolled. Handgrip strength (HGS) was measured to assess muscle strength. Bioelectrical impedance spectroscopy (BIS) was applied to measure the lean tissue index (LTI). Reduced LTI plus decreased HGS was defined as sarcopenia. The prevalence of sarcopenia in PD patients was evaluated. According to the presence or absence of sarcopenia, they were divided into the sarcopenia group and the non-sarcopenia group, and the differences in clinical indicators between the two groups were compared. Multivariate logistic regression was used to explore the risk factors of sarcopenia in PD patients. Results A total of 207 patients were enrolled in the study with age of (55.3±13.7) years and a median PD duration of 22.9(7.3, 60.9) months. Of them, 122 patients (58.9%) were male, 45 patients (21.7%) had diabetics and 32 patients (15.5%) suffered from cardiovascular diseases. There were 27 patients (13.0%) diagnosed with sarcopenia. These patients presented with longer PD duration, more prevalent diabetics, lower residual renal function (RRF) and serum pre-albumin, greater ratio of extracellular water to intracellular water (ECW/ICW) and high sensitive C-reactive protein in contrast with those in the non-sarcopenia group (all P＜0.05). Multivariate logistic analysis showed that male (OR=3.94，95%CI 1.35-11.50，P=0.012), longer PD duration (OR=1.01, 95%CI 1.00-1.02，P=0.029) and higher ECW/ICW (OR=1.09, 95%CI 1.05-1.14，P＜0.001) were independent risk factors of sarcopenia in PD patients. Conclusions Sarcopenia is common in PD patients. Male, longer PD duration and higher ECW/ICW were independent risk factors of sarcopenia in PD patients.     

血液透析患者动脉弹性功能及相关因素分析

目的探讨维持性血液透析（MHD）患者在血液透析前、后脉搏波速度（PWV）和压力反射波增强指数（AIx）水平变化及其相关因素。方法选择92例MHD患者,采用标准袖带水银血压计测量非动脉一静脉内瘘侧上臂坐位血压,动脉脉搏波分析仪检测动脉弹性指数AIx和PwV,并分别与各因素进行单因素相关分析和多元逐步回归分析。结果血液透析患者的袖带血压、中心动脉压、PWV和AIx在血液透析前后均无显著性变化（P〉0．05）;多元逐步回归分析表明,AIx与患者的年龄、性别、主动脉收缩压有明显相关（P〈0．05）,而PWV与患者年龄、上臂舒张压、钙磷乘积、身高、透析时间和心率存在明显相关（P〈0．05）;PWV与AIx之间有明显相关（P〈0．05）。结论（1）血液透析患者的AIx与PWV、中心动脉压收缩压（C_SP）、身高、血清白蛋白、性别和年龄存在相关关系,其中与PWV、性别、年龄和C_SP呈正相关;而与身高和血清白蛋白呈负相关。（2）血液透析患者的PWV与AIx、年龄、舒张压、钙磷乘积、身高、透析时间和心率存在相关关系,其中与AIx、年龄、钙磷乘积、舒张压、透析时间及心率呈正相关,仅与身高呈负相关。     

Related factors of pre-dialysis blood pressure variability in under-age patients undergoing maintenance hemodialysis

Objective To explore the blood pressure variability (BPV) in pediatric patients undergoing maintenance hemodialysis (MHD) and to assess the factors associated with pre-dialysis BPV(pre-HD BPV). Methods The pediatric patients who undergone regular dialysis for more than twelve months from Oct 2005 to Oct 2011 in hemo dialysis center of Guizhou Provincial People's Hospital were divided into high pre-HD BPV group and low pre-HD BPV group. Baseline characteristics, biochemical indexes and cardiac function parameters measured by echocardiography were collected in both groups and multiple linear regression analysis was performed. Results Pediatric patients in high pre-HD BPV group demonstrated significantly higher inter-dialytic weight growth rate (IDWG), pre-dialysis systolic blood pressure and average amount of dehydration than those in low pre-HD BPV group (P＜0.05), while significantly lower hemoglobin and albumin levels than those in low pre-HD BPV group (P＜0.05). Comparison among laboratory indicators, serum phosphorus and parathyroid hormone demonstrated significant difference between groups (P＜0.05). For all pediatric patients, pre-HD BPV was positively correlated with IDWG (β=0.165), pre-dialysis systolic blood pressure (β=0.259), and iPTH (β=0.187), while negatively correlated with hemoglobin level (β=-0.199). Conclusions Increasing IDWG, higher pre-dialysis systolic blood pressure, anemia and secondary hyperparathyroidism influence BPV in pediatric patients on MHD.     

Risk factor analysis of pneumonia in maintenance hemodialysis patients

Objective To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non- pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results (1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P＜0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P＜0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95%CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95%CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant ( 60.6% vs 84.4%, χ2=16.647, P＜0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95%CI 0.832-0.909, P＜0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95%CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.     

Clinical characteristics and risk factors of infection-related hospitalization in maintenance hemodialysis patients

Objective To explore the clinical characteristics and risk factors of maintenance hemodialysis (MHD) patients combined with infection-related hospitalization. Methods Patients with MHD from December 1, 2013 to February 28, 2018 were retrospectively selected and then followed up for at least 1 year until February 28, 2019. Baseline data including demographic and clinical data of patients were collected. According to whether the infection-related hospitalization occurred, patients were divided into infection group and non-infection group. The clinical characteristics and related factors were compared between the two groups. Logistic regression model was used to analyze the influencing factors. Results A total of 392 patients were included in the study. Two hundred and fifty-five cases were males, accounting for 65.1%. The age was (59.39±15.28) years old. The infection rate of diabetic kidney disease patients was the highest (32.2%). The main site of infection was the lung, accounting for 78.4%, which was far higher than the catheter-related infection in the second position. After infection, quinolones and cephalosporins were often the preferred drugs. Compared with the non-infection group, the infection group had older age [(62.96±15.16) years vs (57.98±15.12) years, t=-2.607, P=0.004], higher proportion of comorbid diabetes (45.9% vs 32.4%, χ2=6.334, P=0.012) and previous smoking history (30.6% vs 18.5%, χ2=6.831, P=0.009), longer time of first dialysis stay [13.0(9.0, 18.0) d vs 12.0(9.0, 17.5) d, Z=3.659, P=0.001] and lower hemoglobin [(74.43±19.93) g/L vs (79.06±17.10) g/L, t=1.612, P=0.022] , albumin [(32.63±5.33) g/L vs (33.99±6.14) g/L, t=2.062, P=0.029] and red blood cell count [2.53×1012/L (2.06×1012/L, 3.06×1012/L) vs 2.68×1012/L(2.28×1012/L, 3.07×1012/L), Z=2.118, P=0.034]. Multivariate logistic analysis found that older age (every 1 year, OR=1.016, 95%CI 1.003-1.030, P=0.017) and longer hospital stay at first dialysis (every 1 d, OR=1.047, 95%CI 1.014-1.080, P=0.008) were independent risk factors, and higher hemoglobin (every 1 g/L, OR=0.987, 95%CI 0.975-0.999, P=0.033) was a protective factor for infection-related hospitalization in MHD patients. Conclusions MHD patients with diabetic kidney disease have the highest infection incidence. The incidence of pulmonary infection is much higher than other types of infection such as catheter-related infection, urinary tract infection and sepsis. Aging and low hemoglobin are risk factors for MHD patients to prone to co-infection.     

维持性血液透析患者透析间期血压节律影响因素的分析

目的 观察维持性血液透析患者透析间期血压节律可能存在的异常并讨论其影响因素。 方法 选择44例维持性血液透析患者，均于透析间期(透析前1 d)进行24 h动态血压监测，根据动态血压监测结果将患者分为3组：非高血压组、高血压控制组及高血压未控制组。监测或评估3组患者的血红蛋白(Hb)、血肌酐(Scr)、Kt/V、血清钙(Ca)、磷(P)、全段甲状旁腺素(iPTH)、透析间期体质量增加(IDWG)、Morisky依从性评分等。对相应的指标进行统计分析，筛选出影响血压节律的因素。 结果 （1）动态血压相关参数包括夜间血压下降率、收缩压和舒张压的夜间下降率、动态动脉硬化指数(AASI)、杓形血压比例在3组之间的差异无统计学意义。高血压未控制组的24 h平均脉压比其他两组高[（80.06±13.41）比（53.00±7.73）、（57.85±21.97） mm Hg，均P < 0.01]。（2）3组患者血压曲线均呈现“两峰一谷”的表现，高血压未控制组夜间血压下降不明显。（3）夜间收缩压下降率与血iPTH呈负相关(r = －0.349， P = 0.024)。（4）44例患者中的全部10例杓型血压节律者的AASI与夜间舒张压下降率呈负相关(r = －0.748，P = 0.013)。 结论 维持性血液透析患者夜间血压下降与甲状旁腺素及血管硬化程度有关。     

Clinical characteristic and correlative factors of maintenance hemodialysis patients with restless legs syndrome

Objective To explore the prevalence and the correlative factors of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients. Methods The basic information and clinical laboratory results of 307 MHD patients were collected. The international RLS study group (IRLSSG) diagnostic criteria were applied to assess the presence and the severity of RLS. Binary logistic analysis was used for exploring correlative factors of RLS. Results The prevalence of RLS was 12.1% in the MHD patients, with 73.0% patients having mild-to-moderate symptoms and 83.8% having chronic RLS. There was no significant difference between MHD patients with and without RLS in age, gender, dialysis age, daily urine, Kt/V, history of smoking, drinking, hemoglobin, serum creatinine, urea nitrogen, uric acid, calcium, phosphorus, magnesium, potassium, intact parathyroid hormone (iPTH), prealbumin, albumin and alkaline phosphatase. But the frequency of daily exercise in RLS group is significantly lower than that in non-RLS group (Z=-4.114, P＜0.001). Logistic regression analysis showed that daily exercise was a correlative factor of RLS (B=-2.203, OR=0.111, 95%CI 0.033-0.371, P＜0.001). Conclusions RLS is a common complication in MHD patients, with chronic state and mild-to-moderate symptoms. RLS is correlated with daily exercise, which may be a scientific approach to treat or prevent this disease.     

维持性血液透析患者睡眠质量及其影响因素的研究

目的 调查维持性血液透析(MHD)患者的睡眠状况,了解影响MHD患者睡眠质量的相关因素.方法 采用方便抽样方法,抽取中山大学附属第一医院、中山大学附属第二医院、广东省东莞市东华医院、江门市新会区人民医院、河源市人民医院、佛山市顺德区中医院及云南省楚雄市人民医院的MHD患者424例为研究对象.以匹茨堡睡眠质量指数量表( PSQI)、不安腿综合征诊断及评分标准、社会支持评定量表、综合主观性营养评估、家庭关怀度指数问卷、疾病家庭负担量表及自设的一般情况调查表调查MHD患者的睡眠状况并分析其影响因素.结果 395例(93.2％)患者PSQI总分≥5分.家庭关怀度及社会支持与睡眠指数得分呈负相关(r=-0.133,P=0.006;r=-0.105,P=0.031).疾病负担与睡眠指数得分呈正相关(r=0.215,P=0.000).营养状况(F=46.123,P=0.000)、不安腿综合征(F=9.392,P=0.000)、睡眠呼吸暂停综合征(F=5.645,P=0.001)与睡眠指数得分密切相关.结论 MHD患者睡眠质量差的发生率相当高,其睡眠质量与家庭关怀度、社会支持等多个因素相关.     

Association of serum magnesium level with all-cause mortality in maintenance hemodialysis patients

Objective To investigate the association of serum magnesium (Mg) level with all-cause mortality in maintenance hemodialysis patients. Methods A multicenter retrospective cohort study was conducted in seven hemodialysis centers of Guizhou province. The adult outpatients who underwent hemodialysis for more than 3 months were included from June 2015 to June 2016. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until June 30, 2018. Patients were divided into 4 groups according to their baseline serum Mg levels (interquartile range). Kaplan-Meier method was used to compare the survival rates of the four group. Cox regression model was used to analyze the association of Mg with all-cause mortality. Logistic regression was used to analyze the influencing factors of low Mg level. Results A total of 868 hemodialysis dialysis patients with baseline Mg data were enrolled in this study, with age of (55.47±16.17) years old, among whom 59.4% were male. There were 11 (1.3%) patients with hypomagnesemia (Mg＜0.7 mmol/L), 432(49.8%) patients with hypermagnesemia (Mg＞1.05 mmol/L), and 16(1.8%) patients with Mg＞2.0 mmol/L. Median Mg was 1.05 mmol/L and interquartile range was 0.95-1.24 mmol/L. The comparison between Mg quartile groups showed that the difference in age, hemoglobin, serum albumin, serum calcium, parathyroid hormone (PTH), serum creatinine, uric acid and urea nitrogen was statistically significant (all P＜0.05). After a median follow-up of 24 months, 207 patients died. Kaplan-Meier curves showed higher all-cause mortality in patients with Mg≤0.95 mmol/L (Q1 group) (Log-rank test χ2=15.11, P=0.002). However, after adjusting for age, comorbidities and biochemical indicators(especially albumin), there was no statistically significant difference in the hazard ratio for all-cause death among the four groups. Multiple logistic regression analysis results showed that low serum albumin (OR=0.946, 95%CI 0.913-0.979, P=0.002) and low serum uric acid (OR=0.994, 95%CI 0.992-0.997, P＜0.001) were the risk factors for baseline Mg≤0.95 mmol/L. Conclusions Hypomagnesemia is rare in MHD patients, while hypermagnesemia is more common. Baseline serum Mg≤0.95 mmol/L in MHD patients is correlated with increased risk of all-cause death, but it may be not an independent risk factor. Baseline serum Mg≤0.95 mmol/L that occurred is associated with low levels of albumin and serum uric acid.     

Reasons for the dropout of peritoneal dialysis patients

Objective To explore the reasons for withdrawal from peritoneal dialysis (PD) in our hospital. Methods This was a single-center, retrospective cohort study. Patients who started PD in the Department of Nephrology, the First Affiliated Hospital of Nanchang University from November 1st, 2005 to February 28th, 2017, were enrolled, and followed up to May 31, 2017. Patients who continued PD after May 31, 2017 were as the control group. Patients who withdrew from PD were divided into 4 subgroups: death group, hemodialysis group, kidney transplantation group and loss of follow-up group. The clinical characters of 4 subgroups were compared with the control group. Results A total of 998 patients were enrolled with age of (49.36±14.94) when PD started and median dialysis duration of 27.13(12.84, 42.29) months, in whom 570 patients (57.11%) were male. Five hundred and seventeen dropout events were recorded, and the dropout rate was 51.80%. The main reason for withdrawal from PD was death (258 patients, 49.90%), followed by hemodialysis (166 patients, 32.11%), kidney transplantation (66 patients, 12.77%) and loss to follow-up (27 patients, 5.22%). The leading cause of death was cardio-cerebro-vascular diseases (136 cases, 52.71%), followed by infection (42 cases, 16.28%), dyscrasia (20 cases, 7.75%) and tumor (5 cases, 1.94%). The main reason for transfering to hemodialysis was insufficient dialysis (76 cases, 45.78%), followed by peritonitis (55 cases, 33.13%) and catheter dysfunction (24 cases, 14.46%). Compared with those in the control group, in the death group patients were older at PD commencement, and had higher proportions of hypertension, diabetes and cardio-cerebro-vascular diseases (all P＜0.05). The proportions of male and diabetes mellitus were higher in the hemodialysis group than those in the control group (both P＜0.05). Biochemical indicators showed that serum albumin and blood phosphorus were lower in the death group than those in the control group (both P＜0.05); blood albumin was significantly lower in the hemodialysis group than that in the control group (P＜0.05). Conclusions The main reasons for withdrawal from PD in our center are death and transfering to hemodialysis. The cardio-cerebro-vascular disease is the leading cause of death, and inadequate dialysis is the main reason for transfering to hemodialysis.     

维持性血液透析患者缺血性脑卒中发生的影响因素及预后分析

目的探讨维持性血液透析（MHD）患者缺血性脑卒中的危险因素及影响其预后的因素。方法在我院2004年1月至2008年12月行MHD治疗的216例患者中,选择发生缺血性脑卒中的患者25例,为脑卒中组;选择同期无脑卒中者42例,为非脑卒中组。比较2组患者临床及生化指标。Logistic回归分析MHD患者缺血性脑卒中发生的危险因素,同时分析脑卒中组患者的转归。结果（1）脑卒中组年龄、收缩压（SBP）、脉压（PP）、脉压指数（PPI）、进入MHD后平均动脉压（MAP）的增加值、尿酸（UA）、C反应蛋白（CRP）、纤维蛋白原、总胆固醇（TC）／高密度脂蛋白胆固醇（HDLC）比值以及合并高血压、糖尿病的比例均高于非脑卒中组,而血压控制满意率、血清白蛋白（Alb）、HDL-C低于非脑卒中组,差异均有统计学意义（P〈0．05）;（2）Logistic回归分析表明,合并糖尿病、SBP、PPI、Alb、TC／HDL-C比值（0分别为1．265、1．032、1．655、0．625和3．087,P〈0．05）是MHD患者并发缺血性脑卒中的危险因素;（3）脑卒中组死亡7例,存活18例,死亡组年龄、透析龄、合并糖尿病的比例高于存活组,血红蛋白、Alb低于存活组,差异均有统计学意义（P〈0．05）。结论MHD患者缺血性脑卒中的发生与高血压、糖脂代谢紊乱、营养不良和炎症状态有关。纠正贫血、改善透析质量以纠正营养不良一炎症状态可能改善透析合并脑卒中患者的预后。     

Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease

Abstract

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6?±?1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) (r?=?0.23, 0.20; p?=?0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP (r?=?0.19, 0.31; p?=?0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient (β)?=?0.19, 0.34; p?=?0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV.     

Relationship between ultrafiltration rate and cardiovascular death in maintenance hemodialysis patients

Objective To investigate the relationship between ultrafiltration rate (UFR) and cardiovascular death in maintenance hemodialysis patients. Methods This retrospective study observed adult hemodialysis patients treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University during January 2010 to December 2015 and the follow-up were finished at April 2017. Patients were averagely divided into 3 groups according to their UFR. Their clinic characteristics were collected, the survival rate and death related factors were analyzed by Kaplan-Meier (Log-rank test) method and Logistic regression. Results Totally 2184 patients (male 1370, 62.7%) were enrolled, the age was 53.39±16.47. The UFR was (8.88±3.05) ml?h-1?kg-1. During the 7 years' follow-up, 168 patients died, of whom 58 cases (34.5%) died due to the cardiovascular events. Chi-square test showed that there were significant differences in death causes among the high, middle and low UFR group (χ2=12.584, P＜0.01), and the mortality rate of cardiovascular events in high UFR group was significantly higher than that in low (χ2=10.861, P= 0.010) and middle UFR group ( χ2=4.671, P=0.031). Kaplan-Meier survival curve showed that the difference of the survival rates in the 3 groups was statistically significant (Log-rank test χ2=23.394, P＜0.001). Cox regression analysis showed that high UFR (UFR≥10.95 ml?h-1?kg-1), old age (＞60 years old), and low left ventricular ejection fraction (LVEF, ≤50%) were independent risk factors of cardiovascular death. Conclusions High UFR level, old age and low LVEF are independent risk factors of cardiovascular death in hemodialysis patients. Maintaining low UFR level is beneficial to reduce cardiovascular mortality in hemodialysis patients.     

探讨透析液钙浓度对血液透析患者血压及血清钙磷变化的影响

目的观察不同钙离子浓度的透析液对血液透析患者血压及血清钙磷代谢的影响,为血液透析患者的高血压及高钙血症的防治提供参考。方法选取我院血液净化中心维持性血液透析患者15例,采取自身对照的方法,先后应用钙浓度为1．75mmol／L（dCa2＋1．75）及1．50mmol／L（dCa2＋ 1．5）的透析液各连续进行35次透析,记录每次透析上机前、1h、2h、3h及透析结束后的血压,并分别于第1次及第35次透析前后观察一般临床指标及血清总钙、磷、钙磷乘积、甲状旁腺素及碱性磷酸酶的变化。结果两种透析液一般指标差异无显著性（P〉O．05）。与采用dCa2＋ 1．75相比,采用dCa2＋ 1．5进行透析,患者的血压降低,尤其在透析3h及透析结束后,差异有显著性（P〈0．05或P〈0．01）,透析后磷升高,差异有统计学意义（P〈0．05）,其他指标变化无显著性（P〉0．05）。结论透析液钙离子浓度与血液透析患者血压呈正相关,低钙透析液透析有助于维持性血液透析患者高血压的控制,但本研究未观察到其对血清钙浓度的影响。     

维持性血液透析患者外周动脉疾病及危险因素分析

目的通过测量踝肱指数调查维持性血液透析患者下肢外周动脉疾病的患病率及危险因素。方法纳入我院血液净化中心179例维持性血液透析患者,对其进行问卷、体格检查、实验室检查及踝肱指数测量。以任何一侧踝肱指数〈0．90作为下肢外周动脉疾病的诊断标准,分析其患病率及危险因素。结果我院血液净化中心下肢外周动脉疾病的患病率为12．8％（23／179）,男女患病率无差异。年龄大于65岁患者外周动脉疾病患病率为18．9％,低于65岁患者为8．6％。高三酰甘油血症患者外周动脉疾病患病率为18．7％,非高三酰甘油血症患者为7．7％。有脑血管疾病患者比无脑血管疾病患者外周动脉疾病患病率高（33．3％：11．3％,P〈0．05）。Logistic分析显示,年龄（优势比为1．036-1．276,P=0．009）、慢性肾脏病病程（优势比1．003～1．018,P=0．007）、脑血管疾病（优势比2-202．19,P=0．011）为外周动脉疾病的独立危险因素。结论维持性血液透析患者外周血管疾病患病率较高,年龄、慢性肾脏病病程及脑血管疾病史为此人群外周血管疾病的独立危险因素。