Abstract:

【Abstract】 Objective To investigate the characteristic of blood pressure and the change of blood pressure during hemodialysis (HD) in hemodialysis patients with diabetic mellitus. Methods We studied 3 consecutive HD sessions in 36 stable maintained HD (MHD) patients (totally 108 dialysis sessions), and divided the patients into 2 groups: diabetic group and non-diabetic group. Blood pressures before and after dialysis were compared between the two groups. HD-related hypotension was also analyzed. Results The ratio of patients with the blood pressure reached to the target of K/DOQI was 26.7% (pre-dialysis) and 57.8% (post-dialysis) in diabetic patients, and was 28.6% (pre-dialysis) and 55.6% (post-dialysis) in non-diabetic patients, without significant differences between the two groups. The number of patients taking anti-hypertensive medicines and the kinds of a tensive medicines administered were more in diabetic group than in diabetic group (P＜0.05). In patients before dialysis, the average systolic blood pressure (SBP) and pulse pressure (PP) were 163+29mmHg and 83+25mmHg, respectively, in diabetic group, higher than those in non-diabetic group (153+23mmHg and 70+22mmHg, respectively; P＜0.05). However, diastolic blood pressure (DBP) had no significant differences between the two groups. In patients after dialysis, SBP and PP showed no significant differences between the two groups, and DBP was lower in diabetic group than in non-diabetic group (70+14mmHg and 80+15mmHg, respectively; P＜0.05). In diabetic group after dialysis, SBP and DBP decreased by 37+38mmHg and 10+17mmHg, respectively, as compared with the values before dialysis. In non-diabetic group after dialysis, the decrease of SBP and DBP were less (19+29mmHg and 3+16mmHg, respectively; P＜0.05). In diabetic group, patients with dialysis-related hypotension and symptomatic hypotension were 62.2% and 31.1%, respectively, higher than those in non-diabetic patients (41.3% and 7.9%, respectively; P＜0.05). Multiple regression analysis indicated that diabetes and higher ultrafiltration volume were the risk factors for HD-related hypotension. Conclusion The ratio of patients with the blood pressure reached to the target of K/DOQI was very low in this study. Patients with diabetes had hypertension more difficult to control and a higher PP. These patients also showed wider change of blood pressure during HD, and were prone to HD-related hypotension.

Key words: Diabetic mellitus, Blood pressure, Pulse pressure, Hypotension