Objective To explore the relationships between dialysis adequacy and cardiovascular structure and function in patients with maintenance hemodialysis (MHD). Methods Clinical data with respect to blood biochemical examinations, vascular calcification and 12 consecutive dialysis treatments were retrospectively collected for patients receiving hemodialysis more than three months. Adequate dialysis was defined as the urea reduction rate (URR)≥65% and single-pool urea clearance (spKt/V)1.2. Blood pressure variability (BPV) metrics including the difference in maximum and minimum BPs (△BP) and average real variation (ARV) were calculated, and multivariate regression analyses were conducted. Results A total of 90 Chinese MHD outpatients were included, with the mean age of 59.8±17.4 years and the median dialysis vintage of 28.3(12.3～46.8) months. Patients with inadequate dialysis (45 patients) had higher intradialysis systolic ΔBP (27.9±6.6 vs. 25.1±6.5 mmHg, t=-2.035, P=0.045) and systolic BP-ARV [SBP-ARV (13.4 ± 3.4) vs. (11.9 ± 3.2)mmHg, t=-2.228, P=0.028] and greater coronary artery calcification score [CACs, 461.0(96.0～1741.0) vs. 99.5(1.0～1329.0), t=-2.045, P=0.041] than those with adequate dialysis (45 patients). Age (β=0.305, P=0.003), coronary heart disease (β= -0.255, P=0.014) and spKt/V (β= -0.290, P=0.006) were significantly correlated with intradialysis SBP-ARV; diabetes mellitus (OR= 6.048, 95% CI:1.168～31.330, P=0.032), low serum albumin levels (OR=0.817, 95% CI:0.681～0.982, P=0.031) and spKt/V (OR=0.886, 95% CI:0.786～0.998, P=0.047) were found to be independent risk factors for CACs≥400.Conclusions Inadequate dialysis was strongly associated with elevated intradialysis BPV and increased risk of severe coronary artery calcification in MHD patients.
YOU Nu-Jia
,
XIONG Yu-Qin
,
LIU Yao
,
MA Qiu
,
LIAO Ruo-Xi
,
WU Ling
,
LING Zi-Ying
,
YU Yang
. Impact of dialysis adequacy on blood pressure variability and vascular calcification in patients undergoing maintenance hemodialysis[J]. Chinese Journal of Blood Purification, 2024
, 23(06)
: 416
-420
.
DOI: 10.3969/j.issn.1671-4091.2024.06.004
[1] Yang C, Yang Z, Wang J, et al.Estimation of Prevalence of Kidney Disease Treated With Dialysis in China: A Study of Insurance Claims Data [J][J]. Am J Kidney Dis, 2021, 77(6):889-897
[2] 中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J][J].中华医学杂志, 2015, 95(34):2748-2753
[3] Hong WP, Lee YJ.The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients [J][J].BMC Nephrol, 2019, 20(1):382-382
[4] Aghsaeifard Z, Zendehdel A, Alizadeh R, et al.Chronic hemodialysis: Evaluation of dialysis adequacy and mortality [J][J].Ann Med Surg (Lond), 2022, 76:103541-
[5] Mayer CC, Matschkal J, Sarafidis PA, et al.Association of Ambulatory Blood Pressure with All-Cause and Cardiovascular Mortality in Hemodialysis Patients: Effects of Heart Failure and Atrial Fibrillation [J]. J Am Soc Nephrol. 2018; 29(9): 2409-2417.
[6] Xiong Y, Yu Y, Jiang H, et al.Visceral Fat Area Is a Better Predictor Than Coronary Artery Calcification Score for Cardiovascular Outcomes and All-Cause Death in Patients on Hemodialysis [J]. J Ren Nutr. 2021; 31(3): 306-312.
[7] Momciu B, Chan CT.Evaluating dialysis adequacy: Origins, evolution, and future directions [J]. Semin Dial. 2020; 33(6): 468-474.
[8] 廖若西, 林丽萍, 李佳梦等.维持性血液透析患者血压变异性评估[J]. 华西医学. 2018, 33(07): 905-908.
[9] Xiong Y, You N, Liao R, et al.Association of intradialysis blood sodium level, blood pressure variability, and hydration status with hemodialysis-related headache: a prospective cohort study [J]. J Headache Pain. 2023; 24(1): 166.
[10] Devereux RB, Reichek N.Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method [J]. Circulation. 1977; 55(4): 613-8.
[11] Stevenson PH.Height-Weight-Surface formula for the estimation of surface area in Chinese subjects [J]. Chin J Physiol (中国生理学杂志). 1937; 3: 327-330.
[12] Liao R, Li J, Xiong Y, et al.Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients [J]. Kidney Blood Press Res. 2018; 43(4):1352-1362.
[13] Liao R, Li J, Lin L, et al.The Association between Long- and Intra-Dialytic Blood Pressure Variability with All-Cause Mortality in Hemodialysis Patients [J]. Blood Purif. 2019; 48(1): 43-50.
[14] Xiong Y, Li J, Sun S, et al.Association of mineral content outside of bone with coronary artery calcium and 1-year cardiovascular prognosis in maintenance hemodialysis patients [J]. Artif Organs. 2019; 43(10): 988-1001.
[15] Zhang H, Li G, Yu X, et al; China Dialysis Calcification Study Group.Progression of Vascular Calcification and Clinical Outcomes in Patients Receiving Maintenance Dialysis [J]. JAMA Netw Open. 2023; 6(5): e2310909.
[16] McCullough PA, Chan CT, Weinhandl ED, et al.Intensive Hemodialysis, Left Ventricular Hypertrophy, and Cardiovascular Disease [J]. Am J Kidney Dis. 2016; 68(5S1): S5-S14.
[17] Xiong Y, Yu Y, Huang K, et al.Vascular Calcification Exacerbates Abnormal Blood Pressure Variability in Chronic Kidney Disease: A " Two-Step" Study in Rats [J]. Cardiorenal Med. 2023; 13(1): 66-73.
[18] Flythe JE, Inrig JK, Shafi T, et al.Association of intradialytic blood pressure variability with increased all-cause and cardiovascular mortality in patients treated with long-term hemodialysis [J]. Am J Kidney Dis. 2013; 61(6): 966-74.
[19] Lanzer P, Boehm M, Sorribas V, et al.Medial vascular calcification revisited: Review and perspectives [J]. Eur Heart J. 2014; 35: 1515-1525.
[20] Anaya P, Blomquist GA, Davenport DL, et al.Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality [J]. Clin Nephrol. 2016; 86 (2016)(12): 291-302.
[21] Shimoyama Y, Tsuruta Y, Niwa T.Coronary artery calcification score is associated with mortality in Japanese hemodialysis patients [J]. J Ren Nutr. 2012; 22(1): 139-42.
[22] AlSahow A, Muenz D, Al-Ghonaim MA, et al.Kt/V: achievement, predictors and relationship to mortality in hemodialysis patients in the Gulf Cooperation Council countries: results from DOPPS (2012-18) [J]. Clin Kidney J. 2020; 14(3): 820-830.
