目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者发生透析中低血压(intradialytic hypotension,IDH)的独立相关因素，并分析IDH对MHD患者3年全因死亡风险的影响。 方法 采用回顾性队列研究，纳入2021年10月─12月于首都医科大学附属北京潞河医院血液净化中心的MHD患者191例。依据是否发生IDH分为IDH组(n=50)和非IDH组(n=141)。收集患者临床资料，采用单因素及多因素Logistic回归分析识别IDH的独立相关因素。采用Kaplan-Meier法绘制生存曲线，并应用多因素COX比例风险回归模型分析IDH与生存预后的关系。 结果 多因素Logistic回归分析显示：透析前收缩压(OR=0.958，95%CI：0.936～0.981，P＜0.001)、透析前肌酐(OR=0.998，95%CI：0.997～1.000，P=0.037)及白蛋白(OR=0.769，95%CI：0.652～0.907，P=0.002)是MHD患者发生IDH的独立相关因素。生存分析显示，IDH组患者3年累积生存率低于非IDH组(χ²=9.450,P=0.003)。为进一步明确IDH与死亡的独立关联，多因素COX回归在校正年龄、血红蛋白、白蛋白、透析前肌酐、糖尿病史及超滤量后，显示IDH并非患者3年全因死亡的独立危险因素(HR=1.423，95% CI:0.771～2.626，P=0.259)。在校正后的模型中，年龄是死亡的危险因素(HR =1.088，P＜0.001)，血红蛋白是其保护因素(HR=0.971，P=0.015)。 结论 较低的透析前收缩压、白蛋白及透析前肌酐水平是MHD患者发生IDH的独立相关因素。IDH与患者生存率降低显著相关，但其主要反映患者的基础衰弱状态，而非导致死亡的独立风险因素。
Abstract
Objective To investigate the independent factors associated with intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients and to analyze its impact on 3-year all-cause mortality risk. Methods A retrospective cohort study was conducted, which included 191 MHD patients treated at the Blood Purification Center of Beijing Lu-he Hospital, Capital Medical University, from October to December 2021. According to the occurrence of IDH, the patients were divided into an IDH group (n=50) and a non-IDH group (n=141). Clinical data were collected. Univariate and multivariate logistic regression analyses were performed to identify the independent factors associated with IDH. Kaplan-Meier curve was used, and multivariate Cox proportional hazards regression model was applied to analyze the relationship between IDH and survival prognosis. Results Multivariate logistic regression analysis showed that pre-dialysis systolic blood pressure (OR=0.958, 95% CI: 0.936～0.981, P＜0.001), pre-dialysis creatinine (OR=0.998, 95% CI: 0.997～1.000, P=0.037), and serum albumin (OR=0.769, 95% CI: 0.652～0.907, P=0.002) were the independent factors associated with IDH in MHD patients. Survival analysis revealed that the 3-year cumulative survival rate was significantly lower in the IDH group than in the non-IDH group (42% vs. 72%, log-rank χ²=9.450, P=0.003). To further clarify the independent association between IDH and mortality, multivariate COX regression after adjustment for age, hemoglobin, albumin, pre-dialysis creatinine, diabetes history, and ultrafiltration volume indicated that IDH was not an independent risk factor for 3-year all-cause mortality (HR=1.423, 95% CI: 0.771～2.626, P=0.259). In the adjusted model, age (HR=1.088, P＜0.001) was a risk factor for death, while hemoglobin(HR=0.971,P=0.015) served as a protective factor. Conclusion Lower pre-dialysis systolic blood pressure, serum albumin, and pre-dialysis creatinine levels are the independent factors associated with IDH in MHD patients. IDH is significantly correlated with reduced patient survival, but it primarily reflects the underlying frail state of the patients rather than acting as an independent risk factor for mortality.
关键词
维持性血液透析 /
透析中低血压 /
相关因素 /
生存分析
Key words
Maintenance hemodialysis /
Intradialytic hypotension /
Associated factor /
Survival analysis
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基金
北京市自然科学基金面上专项项目(M22009)
