维持性血液透析患者透析间期血压变异性影响因素的多中心研究

目的探讨珠三角地区维持性血液透析(maintenance hemodialysis,MHD)患者透析间期血压变异性(blood pressure variability,BPV)的影响因素,旨在为临床防治提供依据。方法对珠三角地区10家血液透析中心的MHD患者进行回顾性分析,根据患者透析间期收缩压变异系数(systolic blood pressure-coefficient of variation,SBP-CV)的四分位数将患者分成4组,记录患者的临床资料、生化指标及用药情况,比较组间差异并对有意义的指标进行二分类Logistic回归分析。结果共纳入1010例患者,男性612例,女性398例,年龄(56.3±13.9)岁,透析龄(48.4±36.1)个月,透析间期SBP-CV为8.07%(5.72%,11.34%)。根据患者透析间期SBP-CV的四分位数分成4组:低BPV组(SBP-CV≤5.72%,253例)、中BPV组(5.72%11.34%,252例),组间透析龄、合并糖尿病、超滤量、透析间期体重增长率(interdialysis weight gain rate,IDWGR)、血钙、使用钙通道拮抗剂比例的差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,高IDWGR(OR=1.216,95%CI 1.108~1.435,P<0.001)是BPV的独立危险因素,高超滤量(OR=0.436,95%CI 0.330~0.575,P<0.001)、使用钙通道拮抗剂(OR=0.686,95%CI 0.477~0.986,P=0.042)是BPV的独立保护因素。结论高IDWGR是MHD患者透析间期BPV的独立危险因素,高超滤量、使用钙通道拮抗剂是MHD患者透析间期BPV的保护因素。

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta, and provide clinically useful information for the prevention and treatment of BPV. Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively. According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV), patients were divided into four groups, and clinical data, biochemical indicators and drug use were compared among 4 groups. Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV. Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study. Their dialysis duration was (48.4±36.1) months, and the median of interdialysis SBP-CV was 8.07% (5.72%, 11.34%). According to the quartile of SBP-CV, the patients were divided into four groups: low BPV group (SBP-CV≤5.72%, 253 cases), middle BPV group (5.72%＜SBP-CV≤8.07%, 252 cases), high BPV group (8.07%＜SBP-CV≤11.34%, 253 cases) and extremely high BPV group (SBP-CV＞11.34%, 252 cases), and the dialysis duration, diabetes, ultrafiltration, interdialysis weight gain rate (IDWGR), serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P＜0.05). Logistic multiple regression analysis showed that high IDWGR (OR=1.216, 95%CI 1.108-1.435, P＜0.001) was an independent risk factors for interdialysis BPV in MHD patients, while high ultrafiltration volume (OR=0.436, 95%CI 0.330-0.575, P＜0.001) and calcium channel antagonists used (OR=0.686, 95%CI 0.477-0.986, P=0.042) were independent protective factors. Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients, while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.