Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients.


  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000021232
  • 作者列表:"Cheng Y","Li Y","Zhang F","Zhu J","Wang T","Wei M","Mo L","Li Y
  • 发表时间:2020-07-17

:Studies on nondialysis populations have linked visit-to-visit blood pressure (BP) variability (BPV) to cerebrovascular events and mortality. In view of the high prevalence of hypertension in hemodialysis patients, the predictive values of numerous factors for stroke, especially visit-to-visit BPV, were evaluated in this prospective cohort study.A total of 151 patients were enrolled in this study. The demographic features and various laboratory parameters were analyzed. At each routine hemodialysis visit, the predialysis, intradialysis, and post-dialysis BP measurements were systematically performed. We defined BPV using 4 metrics: standard deviation of the BP, coefficient of variation, average real variability (ARV), and variability independent of mean (VIM). Differences in the predialysis BPs from one treatment to the next (ie, interdialytic variability) and differences in the BPs from predialysis to post-dialysis (ie, intradialytic variability) were both studied in this work.Twenty-one patients developed stroke and 25 patients died. The multivariate Cox proportional hazards regression model revealed a significant relationship between stroke and the interdialytic BPV (both predialysis systolic BP variability and predialysis diastolic BP variability) and low-density lipoprotein-cholesterol (LDL-C).Our results indicate that a high interdialytic BPV is associated with an increased risk for stroke that is independent of several factors, including age, sex, antihypertensive medication use, and mean BP over time. There is potential that the optimal treatment goal for hemodialysis patients may be to reduce the interdialytic BPV rather than either the mean BP or the intradialytic BPV.


: 关于非透析人群的研究已将访视间血压 (BP) 变异性 (BPV) 与脑血管事件和死亡率联系起来。鉴于血液透析患者高血压的高患病率,在这项前瞻性队列研究中评估了许多因素对卒中的预测价值,尤其是访视BPV。共有151名患者参加了这项研究。分析了人口统计学特征和各种实验室参数。在每次常规血液透析访视时,系统地进行透析前、透析中和透析后BP测量。我们使用4个指标定义BPV: BP的标准偏差、变异系数、平均真实变异性 (ARV) 和独立于平均值的变异性 (VIM)。在这项工作中,研究了透析前BPs从一种治疗到另一种治疗的差异 (即透析间变异性) 和透析前到透析后BPs的差异 (即透析间变异性)。21名患者发生中风,25名患者死亡。多变量Cox比例风险回归模型揭示了卒中与透析间期BPV (包括透析前收缩压变异性和透析前舒张压变异性) 和低密度脂蛋白胆固醇 (ldl-c) 之间的显著关系。我们的研究结果表明,高透析间期BPV与卒中风险增加相关,这与几个因素无关,包括年龄,性别,抗高血压药物的使用,和平均BP随着时间的推移。血液透析患者的最佳治疗目标可能是降低透析间期BPV,而不是平均BP或透析间期BPV。



作者列表:["Touzot M","Seris P","Maheas C","Vanmassenhove J","Langlois AL","Moubakir K","Laplanche S","Petitclerc T","Ridel C","Lavielle M"]

METHODS:AIM:Clinical interpretation of B-type natriuretic peptide (BNP) levels in haemodialysis (HD) patients for fluid management remains elusive. METHODS:We conducted a retrospective observational monocentric study. We built a mathematical model to predict BNP levels, using multiple linear regressions. Fifteen clinical/biological characteristics associated with BNP variation were selected. A first cohort of 150 prevalent HD (from September 2015 to March 2016) was used to build several models. The best model proposed was internally validated in an independent cohort of 75 incidents HD (from March 2016 to December 2017). RESULTS:In cohort 1, mean BNP level was 630 ± 717 ng/mL. Cardiac disease (CD - stable coronary artery disease and/or atrial fibrillation) was present in 45% of patients. The final model includes age, systolic blood pressure, albumin, CD, normo-hydrated weight (NHW) and the fluid overload (FO) assessed by bio-impedancemetry. The correlation between the measured and the predicted log-BNP was 0.567 and 0.543 in cohorts 1 and 2, respectively. Age (β = 3.175e-2 , P < 0.001), CD (β = 5.243e-1 , P < 0.001) and FO (β = 1.227e-1 , P < 0.001) contribute most significantly to the BNP level, respectively, but within a certain range. We observed a logistic relationship between BNP and age between 30 and 60 years, after which this relationship was lost. BNP level was inversely correlated with NHW independently of CD. Finally, our model allows us to predict the BNP level according to the FO. CONCLUSION:We developed a mathematical model capable of predicting the BNP level in HD. Our results show the complex contribution of age, CD and FO on BNP level.

翻译标题与摘要 下载文献
作者列表:["Yeh EL","Chen CH","Huang SC","Huang YC"]

METHODS:AIM:The removal of cysteine during a dialysis procedure may affect glutathione (GSH) concentration, allowing haemodialysis (HD) patients to become more susceptible to oxidative damage. This study was performed to determine whether the change of GSH/glutathione disulfide (GSSG) redox state and GSH redox potential were linked with the change of cysteine or oxidative stress in patients receiving HD treatment. METHODS:Sixty-seven HD patients who had received regular HD treatment were recruited. Plasma GSH, GSSG, cysteine and malondialdehyde (MDA) were measured at both pre- and post-HD. RESULTS:Plasma cysteine, GSH and GSSG levels significantly decreased after the completion of HD, compared to the levels at pre-HD. Plasma MDA concentration, GSH/GSSG ratio and GSH redox potential remained constant during the dialysis session. Plasma GSH and GSSG were positively associated with plasma MDA at post-HD, while GSH redox potential was negatively associated with plasma MDA at post-HD. However, plasma GSH, GSSG, GSH/GSSG ratio and GSH redox potential were not associated with plasma cysteine at either pre- or post-HD. CONCLUSION:The GSH and GSSG levels were significantly utilized during a HD session, and their levels were significantly associated with increased oxidative stress. HD patients may require higher GSH demands to cope with increased oxidative stress during an HD session.

翻译标题与摘要 下载文献
作者列表:["Rafique Z","Aceves J","Espina I","Peacock F","Sheikh-Hamad D","Kuo D"]

METHODS:OBJECTIVE:Although there is no consensus on how to use an electrocardiogram (ECG) in patients with hyperkalemia, physicians often obtain it in the acute setting when diagnosing and treating hyperkalemia. The objective of this study is to evaluate if physicians are able to detect hyperkalemia based on the ECG. METHODS:The study was conducted at a large county hospital with a population of end stage renal disease (ESRD) patients who received hemodialysis (HD) solely on an emergent basis. Five hundred twenty eight ECGs from ESRD patients were evaluated. The prevalence of hyperkalemia was approximately 60% in this cohort, with at least half of them in the severe hyperkalemia range (K ≥ 6.5 mEq/L). RESULTS:The mean sensitivity and specificity of the emergency physicians detecting hyperkalemia were 0.19 (± 0.16) and 0.97(± 0.04) respectively. The mean positive predictive value of evaluators for detecting hyperkalemia was 0.92 (±0.13) and the mean negative predictive value was 0.46 (± 0.05). In severe hyperkalemia (K ≥ 6.5 mEq/L), the mean sensitivity improved to 0.29 (± 0.20), while specificity decreased to 0.95 (±0.07). CONCLUSION:An ECG is not a sensitive method of detecting hyperkalemia and should not be relied upon to rule it out. However, the ECG has a high specificity for detecting hyperkalemia and could be used as a rule in test.

关键词: 暂无
翻译标题与摘要 下载文献