中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (09): 638-643.doi: 10.3969/j.issn.1671-4091.2022.09.004

• 临床研究 • 上一篇    下一篇

不同定义下透析中低血压与血液透析患者全因死亡的相关性研究

曹虎男    樊 蕊   孔 凌    成水芹    陈艺虹    吕桂兰   

  1. 210002 南京， 1东部战区总医院国家肾脏疾病临床医学研究中心血液净化中心
    210093 南京，     2南京大学医学院

  • 收稿日期:2022-03-28 修回日期:2022-06-02 出版日期:2022-09-12 发布日期:2022-09-06
  • 通讯作者: 吕桂兰 E-mail:2271500539@qq.com
  • 基金资助:
    东部战区总医院院管课题(YYHL2021062)

A comparative study on the association of all-cause mortality with different definitions of intradialytic hypotension

CAO Hu-nan,  FAN Rui,  KONG Ling,  CHENG Shui-qin,  CHEN Yi-hong,  LV Gui-lan   

  1. Center of Blood Purification, National Clinical Research Center for Kidney Diseases, General Hospital of Eastern Theater Command, Nanjing 210002, China; 2Medical School of Nanjing University, Nanjing 210093, China
  • Received:2022-03-28 Revised:2022-06-02 Online:2022-09-12 Published:2022-09-06
  • Contact: LV Gui-lan1 E-mail:2271500539@qq.com

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摘要： 目的 比较不同定义下透析中低血压(intradialytic hypotension,IDH)与维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡的关系。 方法 回顾分析407名MHD患者数据，基于9 种不同定义选择K-M曲线差异最大时的IDH发生率作为截断值以区分频发IDH组与非频发IDH组，利用COX回归模型对比频发IDH与全因死亡的关联，同时通过C指数(C-index)、赤池信息准则(Akaike information criterion,AIC)、净重新分类指数(net reclassification index,NRI)和综合判别改善指数(integrated discrimination improvement,IDI)评价模型拟合效果及性能，最后利用限制性立方样条回归探讨IDH发生率与全因死亡的剂量-反应关系。 结果 近56个月的观察期内共收集了198 883次透析数据，最终35名(8.6%)患者死亡，平均死亡率为2.6人/100人年。各定义下从未发生过IDH的人数比例从0到46.4%不等，IDH平均发生率从0.7%到46.0%不等。矫正混杂变量后，基于英国肾脏协会指南定
义的频发IDH与全因死亡相关(HR=6.762,95%CI：3.272～13.977,P＜0.001)，模型C-ndex=0.749，AIC=380.957，NRI=0.381，IDI=0.093；IDH 发 生 率 与 全 因 死 亡 风 险 存 在 非 线 性 关 系 (Wald χ2=3.875,P=0.049)。 结论 IDH发生较普遍，在各定义间差异较大，重新界定后的IDH频发率在各定义间的差异有所减小。英国肾脏病协会指南定义下患者全因死亡风险随IDH发生频率增加而上升，频发IDH与全因死亡显著相关，且模型拟合效果及性能最优，能较好的评估死亡风险，在临床中更具有预测和指导意义。

关键词: ">透析中低血压；血液透析；全因死亡">

Abstract: Objective To compare the association between intradialytic hypotension (IDH) using different definitions and all- cause mortality in maintenance hemodialysis (MHD) patients. Methods Data from 407 patients were retrospectively analyzed. The K-M curves based on the 9 different definitions were established, and the cutoff value for the incidence of IDH with maximum difference in the K-M curve was used to distinguish frequent IDH from non-frequent IDH. Cox proportional hazard regression model was conducted to compare the correlation between frequent IDH and all-cause mortality. C-index, Akaike Information Criterion(AIC), Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were used to evaluate efficiency and quality of the model. Finally, the dose-response effect between the frequency of IDH and allcause mortality was explored by strict cubic spline regression. Results A total of 198,883 dialysis data were collected during the 56-month follow-up period, and 35 patients (8.6%) died with an average death rate of 2.6 per 100 person-years. The proportion of never having IDH using an IDH definition ranged from 0% to 46.4%, and the average incidence of IDH ranged from 0.7% to 46.0%. After adjusting for confounding variables, frequent IDH that defined by the British Kidney Association (UKKA) guidelines was significantly associated with all-cause mortality (HR=6.762, 95% CI:3.272～13.977, P＜0.001). The C-index, AIC, NRI and IDI of the model were 0.749, 380.957, 0.381 and 0.093 respectively; there was a significant non-linear relationship between the frequency of IDH and the risk of all- cause mortality (Wald χ2=3.875, P=0.049). Conclusion
IDH is common, and its incidence varies using different definitions. Redefinition of IDH may reduce the variation. Using the UKKA guidelines, the risk of all-cause mortality increased with the frequency of IDH. Frequent IDH was significantly associated with all-cause mortality, which is closely related to clinical practice to reveal the association between IDH and all-cause mortality.

Key words: Intradialytic Hypotension, Hemodialysis, All-cause Mortality

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