中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (05): 346-349.doi: 10.3969/j.issn.1671-4091.2022.05.010

• 临床研究 • 上一篇    下一篇

糖尿病患者血液透析中低血压的影响因素分析

姚为华1,2刁宗礼1李霞3李京3刘文虎1   

  1. 1首都医科大学附属北京友谊医院 2北京核工业医院 3北京市第六医院
  • 收稿日期:2021-11-05 修回日期:2021-12-07 出版日期:2022-05-12 发布日期:2022-05-12
  • 通讯作者: 刘文虎 E-mail:wenhuliu@mail.ccmu.edu.cn

The influencing factors for intradialytic hypotension in diabetic patients with maintenance hemodialysis  

YAO Wei-hua1,2, DIAO Zong-li1, LI Xia3, LI Jing3, LIU Wen-hu1     

  1.  1Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; 2Department of Nephrology, Beijing Nuclear Industry Hospital, Beijing 102413 China; 3Department of Nephrology, Beijing Sixth Hospital, Beijing 100007, China
  • Received:2021-11-05 Revised:2021-12-07 Online:2022-05-12 Published:2022-05-12

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摘要： 目的探讨糖尿病患者透析中低血压(intradialytichypotension，IDH)的影响因素。方法选择2017年1月～2019年12月北京3家血液透析中心的糖尿病患者140例，根据IDH的发生频率是否超过30%分为IDH组和非IDH组，记录患者的临床资料，分析2组患者IDH的影响因素。结果IDH组101人，非IDH组39人。Logistic回归分析显示超滤率、透析前收缩压是IDH的独立影响因素，OR值和95%CI：分别为：1.229(1.017～1.487)，P=0.033；1.048(1.013～1.083)，P=0.007。ROC曲线预测IDH，透析前收缩压的阈值为159mmHg(1mmHg=0.133kPa)(AUC=0.702，95%CI：0.604～0.801,P＜0.001)；超滤率的阈值为9.5ml/(h·kg)(AUC=0.657，95%CI：0.551～0.762,P=0.004)。结论超滤率、透析前收缩压是糖尿病患者发生IDH的危险因素，建议透析前收缩压质量控制的上限阈值为159mmHg，超滤率的质量控制上限阈值为9.5ml/(h·kg)。

关键词: 糖尿病, 血液透析, 透析中低血压, 透析前收缩压, 超滤率

Abstract: Objectives  To explore the influencing factors for intradialytic hypotension (IDH) in diabetic patients with maintenance hemodialysis (MHD).  Methods  A total of 140 diabetic patients on MHD during January 2017 to December 2019 were recruited from three hemodialysis centers in Beijing. They were divided into two group: IDH group (IDH episodes in more than 30% of dialysis sessions), and non-IDH group (IDH episodes in less than 30% dialysis sessions). Their clinical and laboratory data were collected and the potential impact factors for IDH were evaluated.  Results  There were 101 cases in IDH group and 39 case in non-IDH group. Logistic regression analysis showed that ultrafiltration rate (OR=1.229, 95% CI 1.017~1.487, P=0.033) and pre-hemodialysis systolic blood pressure (OR=1.048, 95% CI 1.013~1.083, P=0.007) were the independent influencing factors for IDH. ROC for the prediction of IDH demonstrated that the threshold of pre-hemodialysis systolic blood pressure was 159mmHg (AUC=0.702, 95% CI 0.604~0.801, P<0.001) and the threshold of ultrafiltration rate was 9.5ml/h/kg (AUC=0.657, 95% CI 0.551~0.762, P=0.004).  Conclusions   Pre-hemodialysis systolic blood pressure and ultrafiltration rate were the risk factors for IDH in diabetic patients with MHD.

Key words: Diabetes, Hemodialysis, Intradialytic hypotension, Pre-hemodialysis systolic blood pressure, Ultrafiltration rate

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