Abstract: 【Abstract】Objective To explore the factors affecting intradialytic blood pressure fluctuation in maintenance hemodialysis (MHD) patients, and to analyze the relationship between intradialytic pressure fluctuation and chronic kidney diseasEmineral and bone disorder (CKD-MBD). Methods A total of 217 MHD patients treated in the 904th Hospital of the Joint Logistics Support Force from March 2015 to March 2020 were retrospectively analyzed. They were divided into high fluctuation group (n=119) and low fluctuation group (n=98). The general data, dialysis parameters and biochemical indicators were compared between the two groups. The risk factors for intradialytic blood pressure fluctuation, and the correlation of intradialytic blood pressure fluctuation
with serum calcium, phosphorus, intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) were then analyzed. Results Compared to the patients in low fluctuation group, patients in high fluctuation group had lower body mass index (BMI) (t=2.077, P=0.039), longer dialysis time (t=5.043, P＜0.001), higher CKD- MBD prevalence (t=6.663, P=0.010), lower ultrafiltration volume and urea clearance index (Kt/V) (t=2.213 and 2.972, P=0.028 and 0.003), lower serum 25- hydroxyvitamin D level (t=2.433, P= 0.016), and higher serum phosphorus and iPTH levels (t=2.868 and 3.426, P=0.005 and 0.001). Dialysis time, phosphorus and iPTH were the independent risk factors for intradialytic blood pressure fluctuation in MHD patients (OR=1.218, 1.294 and 1.230 respectively; 95% CI:1.055~1.405, 1.058~1.584 and 1.027~1.473 respectively;P=0.007, 0.013 and 0.025 respectively); Kt/V was a protective factor for intradialytic blood pressure fluctuation (OR=0.225, 95% CI: 0.058~0.864, P=0.030). The difference of systolic blood pressure (ΔSBP) was significantly higher in patients with CKD-MBD than those without CKD-MBD (t=6.764, P＜0.001). The intradialytic blood pressure fluctuation was positively correlated with serum phosphorus and iPTH levels (r=0.255 and 0.183, P=0.029 and 0.013). Conclusion Dialysis time and dialysis adequacy affected the intradialytic blood pressure fluctuation in MHD patients. Higher blood pressure fluctuation was correlated with serum phosphorus and iPTH levels, which may be involved in the pathogenesis of CKD-MBD in MHD patients.

Key words: Kidney disease, Maintenance hemodialysis, Blood pressure fluctuation, Chronic kidney diseasEmineral and bone disorder, Correlation