Chinese Journal of Blood Purification ›› 2024, Vol. 23 ›› Issue (06): 416-420.doi: 10.3969/j.issn.1671-4091.2024.06.004

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Impact of dialysis adequacy on blood pressure variability and vascular calcification in patients undergoing maintenance hemodialysis

YOU Nu-jia, XIONG Yu-qin, LIU Yao, MA Qiu, LIAO Ruo-xi, WU Ling, LING Zi-ying, YU Yang   

  1. West China School of Nursing, Sichuan University, Chengdu 610041, China; 2Department of Toxicology and Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; 3Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; 4Department of Nephrology, Chongqing University Qianjiang Hospital, Chongqing 409000, China
  • Received:2024-01-02 Revised:2024-03-11 Online:2024-06-12 Published:2024-06-12
  • Contact: 610041 成都,3四川大学华西医院肾脏内科/华西肾脏病研究所 E-mail:yuyang@wchscu.cn

Abstract: Objective To explore the relationships between dialysis adequacy and cardiovascular structure and function in patients with maintenance hemodialysis (MHD).  Methods  Clinical data with respect to blood biochemical examinations, vascular calcification and 12 consecutive dialysis treatments were retrospectively collected for patients receiving hemodialysis more than three months. Adequate dialysis was defined as the urea reduction rate (URR)≥65% and single-pool urea clearance (spKt/V)1.2. Blood pressure variability (BPV) metrics including the difference in maximum and minimum BPs (△BP) and average real variation (ARV) were calculated, and multivariate regression analyses were conducted.  Results  A total of 90 Chinese MHD outpatients were included, with the mean age of 59.8±17.4 years and the median dialysis vintage of 28.3(12.3~46.8) months. Patients with inadequate dialysis (45 patients) had higher intradialysis systolic ΔBP (27.9±6.6 vs. 25.1±6.5 mmHg, t=-2.035, P=0.045) and systolic BP-ARV [SBP-ARV (13.4 ± 3.4) vs. (11.9 ± 3.2)mmHg, t=-2.228, P=0.028] and greater coronary artery calcification score [CACs, 461.0(96.0~1741.0) vs. 99.5(1.0~1329.0), t=-2.045, P=0.041] than those with adequate dialysis (45 patients). Age (β=0.305, P=0.003), coronary heart disease (β= -0.255, P=0.014) and spKt/V (β= -0.290, P=0.006) were significantly correlated with intradialysis SBP-ARV; diabetes mellitus (OR= 6.048, 95% CI:1.168~31.330, P=0.032), low serum albumin levels (OR=0.817, 95% CI:0.681~0.982, P=0.031) and spKt/V (OR=0.886, 95% CI:0.786~0.998, P=0.047) were found to be independent risk factors for CACs≥400.Conclusions Inadequate dialysis was strongly associated with elevated intradialysis BPV and increased risk of severe coronary artery calcification in MHD patients.

Key words: Hemodialysis, Dialysis adequacy, Blood pressure variability, Coronary artery calcification, Left ventricular hypertrophy

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