Objective To investigate the effect of blood pressure variability on the function of arteriovenous graft (AVG) in hemodialysis patients. Methods A retrospective study was conducted to collect patients who used AVG as vascular access in December 2020. Blood pressure variability during hemodialysis for 4 consecutive weeks (12 times in total) was analyzed, and the patients were divided into control group (blood pressure variability >17.3, n=40) and observation group (blood pressure variability ≤17.3, n=40) according to the median blood pressure variability. The incidence of thrombosis and auxiliary primary patency rate were observed to explore their correlation. Results A total of 80 patients were included, and the clinical data within one year were observed. The AVG thrombosis rates in the control group and the observation group were 77.5% (31/40) and 22.5% (9/40), respectively, and the difference between the two groups was statistically significant (χ²=24.200, P<0.001). The 12-month auxiliary primary patency rate in the control group was lower than that in the observation group (Log-rank, χ²=63.870, P＜0.001). Conclusion The author believes that the higher the blood pressure variability, the greater the hemodynamic changes, and the higher the risk of thrombosis in AVG. It is recommended to evaluate blood pressure variability in dialysis regularly, and take targeted intervention measures to reduce thrombosis in AVG and improve the auxiliary primary patency rate.
CHEN
. Effect of blood pressure variability on graft arteriovenous fistula function[J]. Chinese Journal of Blood Purification, 2024
, 23(08)
: 616
-619
.
DOI: 10.3969/j.issn.1671-4091.2024.08.010
参考文献：
[1]金其庄,王玉柱,叶朝阳等.中国血液透析用血管通路专家共识(第2版)[J].中国血液净化,2019,18(06):365-381.
[2] 胡永伟,乔彤,张明.血液透析患者人工血管内瘘通畅率及危险因素分析[J].中国血管外科杂志(电子版),2019,11(01):48-51.
[3 ]Al-Jaishi AA, Oliver MJ, Thomas SM, et al. Patency rates of the arteriovenous fistula for hemodialysis:a systematic review and meta-analysis[J].Am J Kidney Dis. 2014 ,63(3):464-78.
[4]叶朝阳.血液透析血管通路技术与应用[M].上海：复旦大学出版社，2011.93
[5] Yang J, Huang J, Yu B, et al.Long-term predialysis blood pressure variability and outcomes in hemodialysis patients[J]. Clin Hypertens (Greenwich). 2022 Feb;24(2):148-155.
[6]Tan RY, Pang SC, Teh SP, et.al. Outcomes of endovascular salvage of clotted arteriovenous access and predictors of patency after thrombectomy[J].Vasc Surg. 2020 Apr;71(4):1333-1339.
[7 ]温静,杨涛,詹申等.人工血管内瘘自体静脉近静脉吻合口狭窄术前影响因素分析[J].中国血液净化,2019,18(05):335-338.
[8 ]全梓林,宋利,孙春艳等.血液透析中血压变异性对移植物动静脉内瘘功能的影响[J].临床肾脏病杂志,2021,21(09):709-714.
[9 ]Lok CE, Sontrop JM, Tomlinson G,et.al. Cumulative patency of contemporary fistulas versus grafts (2000-2010) [J]. Clin J Am Soc Nephrol. 2013 May;8(5):810-818.
[10] Sarafidis PA, Ruilope LM, Loutradis C,et.al. Blood pressure variability increases with advancing chronic kidney disease stage: a cross-sectional analysis of 16?546 hypertensive patients[J]. Hypertens. 2018 May;36(5):1076-1085.
[11]巩楠,张学强,袁铮等.成人维持性血液透析患者透析间期血压变异性独立影响因素探讨[J].中国血液净化,2020,19(10):673-677.
[12] Tatasciore A, Di Nicola M, Tommasi R,et.al. From short-term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial dysfunction[J] . Clin Hypertens (Greenwich). 2020 Jul;22(7):1218-1227.
[13 ] Kim JY, Seo HM, Kim M, et.al A relationship of intradialytic blood pressure variability with vascular access outcomes in patients on hemodialysis[J]. Hemodial Int. 2019 Apr;23(2):158-166.
[14] Sun CY, Mo YW, Lan LJ,et.al. It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study[J]. J Vasc Access. 2020 Nov;21(6):938-944.
[15]李秀季,郑洁,陈燊等.血液透析中血压变异性随年龄变化特点及影响因素分析[J].临床肾脏病杂志,2021,21(06):463-467.
[16] Sarafidis PA, Loutradis C, Karpetas A, et.al.The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients[J]. Nephrol Dial Transplant. 2019 Mar 1;34(3):515-523.
