Objective Intradialytic hypotension (IDH) is one of the most common complications in hemodialysis. The purpose of this study was to predict the risk of IDH in hemodialysis patients by constructing a nomogram model. Methods The hemodialysis patients in Sichuan Provincial People's Hospital from 2014 to 2020 was included in this study. Their basic information, laboratory examinations and dialysis treatment records were collected. A multivariate logistic regression model was designed, and the nomogram model was constructed using R language program to predict the risk of IDH. The receiver operating characteristic curve (ROC) and calibration curves were used to investigate and evaluate the discrimination and calibration of the model, while the decision curve analysis was used to evaluate its clinical validity. Results A total of 3,906 patients and 314,534 dialysis records were included. After regression analysis, age (OR=1.016, 95% CI 1.015~1.017, P＜0.001), gender (male OR=1.280, 95% CI：1.268~1.282, P＜0.001), pre-dialysis systolic blood pressure (＜90mmHg OR=7.242, 95% CI：6.376~8.156, P＜0.001;>140mmHg OR=2.656, 95% CI：2.345~2.996, P＜0.001), pre-dialysis diastolic blood pressure (＜60mmHg OR=3.772, 95% CI：3.596~3.883, P＜0.001; ＞90mmHg OR=1.741, 95% CI：1.707~1.783, P＜0.001), heart rate (＜60/min OR=2.314, 95% CI：2.173~2.461, P＜0.001; >100/min OR=1.456, 95% CI：1.397~1.514, P＜0.001), preliminary ultrafiltration volume (OR=1.350, 95% CI：1.336~1.362, P＜0.001), hemoglobin (OR=1.001, 95% CI：1.001~1.002, P＜0.001) and blood calcium (＜2.25mmol/L OR=1.270, 95% CI：1.211~1.339, P＜0.001; ＞2.75mmol/L OR=1.087, 95% CI 1.068~1.102, P＜0.001) were identified and input into the nomogram. The nomogram shows better discrimination. The area under the receiver operating characteristic (ROC) curve of the training set is 0.729 (95% CI 0.727~0.732), and the internal verification C-index is 0.730; the area under the ROC curve of the test set is 0.727 (95% CI 0.724~0.731). The calibration curve of IDH probability shows the consistency between the predicted probability of nomogram and the actual probability. Conclusion The nomogram model constructed in this study can be used to identify the patients with high-risk of IDH and to help clinicians make personalized diagnosis and treatment interventions for IDH, indicating that this nomogram model may have clinical utilities.
HE Xin
,
ZHAN Ya
,
ZHANG Hong
,
HONG Da-Qing
,
LI Gui-Sen
. Prediction and evaluation of intradialytic hypotension risk in 3,906 hemodialysis patients by a nomogram model [J]. Chinese Journal of Blood Purification, 2022
, 21(05)
: 350
-355
.
DOI: 10.3969/j.issn.1671-4091.2022.05.011
[1]Reilly R F. Attending rounds: A patient with intradialytic hypotension [J]. Clinical journal of the American Society of Nephrology : CJASN, 2014, 9(4): 798-803.
[2]Patel S, Raimann J G, Kotanko P. The impact of dialysis modality and membrane characteristics on intradialytic hypotension [J]. Seminars in dialysis, 2017, 30(6): 518-531.
[3]Stefansson B V, Brunelli S M, Cabrera C, et al. Intradialytic hypotension and risk of cardiovascular disease [J]. Clinical journal of the American Society of Nephrology : CJASN, 2014, 9(12): 2124-2132.
[4]余金波. 维持性血液透析患者透析中低血压的危险因素研究 [J]. 中国血液净化, 2012, 11: 189-193.
[5]van der Sande F M, Dekker M J, Leunissen K M L, et al. Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension [J]. Blood purification, 2018, 45(1-3): 230-235.
[6]Andrulli S, Colzani S, Mascia F. The role of blood volume reduction in the genesis of intradialytic hypotension [J]. American Journal of Kidney Diseases, 2002, 40(6): 1244-1254.
[7]Whitlock G, Lewington S, Sherliker P. Body-mass index and cause-specific mortality in 900000 adults collaborative analyses of prospective studies [J]. Lancet, 2009, 373(9669): 1083-1096.
[8]Philip G. Zager J N, Richard H. Brown. “U” curve association of blood pressure and mortality in hemodialysis patients [J]. Kidney international, 1998, 54(1998): 561-569.
[9]Chang T I, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis [J]. Journal of the American Society of Nephrology : JASN, 2011, 22(8): 1526-1533.
[10]郑雯雯, 鲁春红, 戴小梅. 维持性血液透析患者自体动静脉内瘘失功危险因素的Meta分析 [J]. 中国血液净化, 2019, 18(10): 705-709.
[11]Wong J, Vilar E, Davenport A, et al. Incremental haemodialysis [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2015, 30(10): 1639-1648.
[12]郑可, 侯波, 有慧. 维持性血液透析患者的脑部损害 [J]. 中华肾脏病杂志, 2015, 31(4): 277-282.
[13]Kooman J, Basci A, Pizzarelli F, et al. EBPG guideline on haemodynamic instability [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2007, 22 (Suppl 2): ii22-44.
[14]K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients [J]. American Journal of Kidney Diseases, 2005, 45: 16-153.
[15]Gul A, Miskulin D, Harford A, et al. Intradialytic hypotension [J]. Current opinion in nephrology and hypertension, 2016, 25(6): 545-550.
[16]Flythe J E, Chang T I, Gallagher M P, et al. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference [J]. Kidney international, 2020, 97(5): 861-876.
[17]Chou J A, Streja E, Nguyen D V, et al. Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2018, 33(1): 149-159.
[18]Chou J A, Kalantar-Zadeh K, Mathew A T. A brief review of intradialytic hypotension with a focus on survival [J]. Seminars in dialysis, 2017, 30(6): 473-480.
[19]Inrig J K. Beware Intradialytic Hypotension: How Low Is Too Low? [J]. Clinical journal of the American Society of Nephrology : CJASN, 2018, 13(10): 1453-1454.
[20]Zhang Z, Zhang H, Khanal M K. Development of scoring system for risk stratification in clinical medicine: a step-by-step tutorial [J]. Ann Transl Med, 2017, 5(21): 436-445.
[21]Balachandran V P, Gonen M, Smith J J, et al. Nomograms in oncology: more than meets the eye [J]. The Lancet Oncology, 2015, 16(4): e173-e180.
[22]Wang H, Zhang L, Liu Z, et al. Predicting medication nonadherence risk in a Chinese inflammatory rheumatic disease population: development and assessment of a new predictive nomogram [J]. Patient Prefer Adherence, 2018, 12: 1757-1765.
[23]Wei L, Champman S, Li X, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China [J]. BMJ Open, 2017, 7(10): e017293.
[24]Kanbay M, Ertuglu L A, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management [J]. Clin Kidney J, 2020, 13(6): 981-993.
