摘要
目的基于纵向多维数据分析老年维持性血液透析(maintenance hemodialysis,MHD)患者发生透析中低血压(intradialytic hypotension,IDH)的危险因素。方法本研究为单中心、回顾性观察性研究,回顾分析东部战区总医院国家肾脏疾病临床研究中心血液净化中心2017年4月3日至2021年12月31日的MHD患者资料。以肾脏疾病结果质量倡议所定义的IDH为结局指标,借助广义估计方程进行单因素回归筛选变量后,结合专业知识行多因素回归以探索IDH发生的独立影响因素。以卡方统计量减自由度评价各因素对IDH发生的重要性,敏感性分析通过对缺失数据行2项5重插补实现。结果共纳入156例老年MHD患者,其中男性91例(58.3%),纳入透析数据记录2681例次。2017—2021年各年度IDH发生率波动于8.3%~13.2%,2017—2021年期间IDH总体发生率为11.0%。多因素回归结果显示,透析前收缩压处于140~159 mmHg(1 mmHg=0.133 kPa,以90~139 mmHg为参照:OR=0.482,95%CI 0.273~0.851,P=0.012)、透析前舒张压≥90 mmHg(以60~89 mmHg为参照,90~99 mmHg:OR=4.081,95%CI 2.132~7.809,P<0.001;≥100 mmHg:OR=8.547,95%CI 3.233~22.597,P<0.001)、白蛋白水平(以34~48为参照,<34 g/L:OR=2.677,95%CI 1.592~4.502,P<0.001;>48 g/L:OR=2.692,95%CI 1.102~6.577,P=0.030)、C反应蛋白≥8 mg/L(以<8 mg/L为参照:OR=1.787,95%CI 1.216~2.628,P=0.003)、透析模式为血液透析滤过(以血液透析为参照:OR=2.256,95%CI 1.395~3.648,P=0.001)、实际超滤量/干体重(每增加1%,OR=1.539,95%CI 1.139~2.080,P=0.005)、超滤率(每增加100 ml/h,OR=1.641,95%CI 1.389~1.939,P<0.001)与IDH发生独立相关。重要性分析显示与IDH发生最相关的前三项相关因素为超滤率(χ^(2)-df=32.798)、透析前舒张压(χ^(2)-df=20.757)和白蛋白(χ^(2)-df=19.971),敏感性分析结果表现稳健。结论老年MHD患者IDH发生的独立危险因素分别为超滤率升高、透析前舒张压较高(≥90 mmHg)、白蛋白较低(<34 g/L)、透析模式为HDF、C反应蛋白
Objective To analyze the risk factors for the occurrence of intradialytic hypotension(IDH)in elderly maintenance hemodialysis(MHD)patients based on longitudinal multidimensional data.Methods This was a single-center,retrospective observational study.Data of MHD patients were retrospectively analyzed from April 3,2017 to December 31,2021 in the blood purification center of National Clinical Research Center for Kidney Diseases,General Hospital of Eastern Theater Command.IDH defined by the Kidney Disease Outcomes Quality Initiative was used as outcome indicator.Generalized estimating equations were used for univariate and multivariate regression analysis.The importance of each factor on the occurrence of IDH was evaluated by chi-square statistic minus degrees of freedom,and sensitivity analysis was performed by 5-fold interpolation of missing data.Results A total of 156 elderly patients were enrolled,91(58.3%)of whom were male,and 2681 dialysis data recordings were included.The incidence of IDH from 2017 to 2021 fluctuated from 8.3% to 13.2%,with an average incidence of 11.0%by 2021.The results of multivariate regression showed pre-dialysis systolic pressure of 140-159 mmHg(1 mmHg=0.133 kPa,90-139 mmHg as reference:OR=0.482,95%CI 0.273-0.851,P=0.012),pre-dialysis diastolic pressure≥90 mmHg(60-89 mmHg as reference,90-99 mmHg:OR=4.081,95%CI 2.132-7.809,P<0.001;≥100 mmHg:OR=8.547,95%CI 3.233-22.597,P<0.001),albumin(34-48 as reference,<34 g/L:OR=2.677,95%CI 1.592-4.502,P<0.001;>48 g/L:OR=2.692,95%CI 1.102-6.577,P=0.030),C-reactive protein≥8 mg/L(<8 mg/L as reference:OR=1.787,95%CI 1.216-2.628,P=0.003),hemodiafiltration as the dialysis mode(hemodialysis as the reference:OR=2.256,95%CI 1.395-3.648,P=0.001),actual ultrafiltration volume/dry body mass(per 1% increase,OR=1.539,95%CI 1.139-2.080,P=0.005),and ultrafiltration rate(per 100 ml/h increase,OR=1.641,95%CI 1.389-1.939,P<0.001)were independently associated with the occurrence of IDH.Contribution analysis showed that the top three factors related to IDH were ultr
作者
曹虎男
刘玉秀
樊蕊
孔凌
王芳
吕桂兰
Cao Hunan;Liu Yuxiu;Fan Rui;Kong Ling;Wang Fang;Lyu Guilan(Medical School of Nanjing University,Nanjing 210093,China;Department of Intensive Care Medicine,General Hospital of Eastern Theater Command,Nanjing 210002,China;National Clinical Research Center for Kidney Diseases,General Hospital of Eastern Theater Command,Nanjing 210002,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2023年第2期101-111,共11页
Chinese Journal of Nephrology
基金
东部战区总医院院管课题(YYHL2021062)。
关键词
肾透析
低血压
老年人
危险因素
Renal dialysis
Hypotension
Aged
Risk factors
