The Multicenter Analysis Of Clinical Risk Factors Related To Intradialytic Hypotension In Hemodialysis Patients

Objective:Clinical data of multicenter maintenance hemodialysis patients were retrospectively collected,the indexes of patients with intradialytic hypotension and those without intradialytic hypotension were compared and analyze the relationship between blood pressure changes during dialysis and various data in IDH patients,the risk factors leading to the occurrence of IDH and the factors affecting the degree of blood pressure decline were identified to provide guidance for the clinical prevention and treatment of IDH.Method:1.A selection of 361 MHD patients who underwent dialysis at multiple centers of Jilin Province(Second Hospital of Jilin University,Dunhua City Hospital and Antu County Hospital)from July 2020 to October 2020,and divided them into IDH group and no-IDH group,clinical indicators of enrolled patients were retrospectively collected and analyzed,risk factors of IDH were analyzed by univariate and multivariate logistics regression analysis;2.A selection of 163 IDH patients who underwent dialysis at multiple centers of Jilin University(Second Hospital of Jilin University,Dunhua City Hospital,Antu County Hospital)from July 2020 to October 2020,and divided them into three groups according to the intradialytic systolic blood pressure reduction(Δi SBP)of IDH group:20-30 mm Hg group,30-40 mm Hg group,>40mm Hg group.Through comparative analysis of the relationship between IDH patients ’ blood pressure change and general data and clinical data,bivariate analysis was used to analyze the correlation between Δ i SBP,nadir intradialytic systolic blood pressure(ni SBP),intradialytic mean arterial pressure reduction(Δ i MAP)and various clinical indicators.Result:1.Overall information: a total of 361 patients with MHD were included in this study,compared with no-IDH group,the age,BMI,dialysis age,primary morbidity of diabetic nephropathy,history of diabetes,history of cerebrovascular disease,ultrafiltration rate,high hypersensitivity C-reactive protein(hs-CRP),fasting blood glucose,globulin,alkaline phosphatase(ALP),triglyceride,red blood cell distribution width(RDW)were significantly increased in IDH group(P<0.05);while albumin,albumin/globulin ratio,high-density lipoprotein,serum iron were significantly decreased(P<0.05).2.Analysis of risk factors for IDH:by univariate logistic regression analysis,age,BMI,ultrafiltration rate,primary morbidity of diabetic nephropathy,history of diabetes mellitus,history of cerebrovascular disease,hs-CRP,albumin,globulin,albumin/globulin ratio,RDW,serum iron were risk factors for IDH;further multivariate logistic regression analysis showed that advanced age,high ultrafiltration rate,high hs-CRP level were independent risk factors for IDH(P<0.05).3.The data of Δi SBP groups in IDH patients were compared:divided them into three groups according to Δi SBP :20-30 mm Hg group,30-40 mm Hg group,>40mm Hg group;There was no significant difference in general data between the three groups(P>0.05),ni SBP,ni MAP,parathyroid hormone,high-density lipoprotein,cholesterol and left ventricular end-diastolic diameter(LVDD)of the three groups were not identical,and the differences were statistically significant(P<0.05).Compared with 20-30 mm Hg group,high density lipoprotein level(P=0.015)was significantly decreased in the 30-40 mm Hg group,parathyroid hormone level(P=0.002)was significantly increased,ni MAP(P=0.001),ni SBP(P=0.007)and high density lipoprotein(P=0.006)level were significantly decreased in >40mm Hg group;compared with 30-40 mm Hg group,the cholesterol level(P=0.034)of >40mm Hg group was significantly increased,ni MAP(P=0.012)were significantly decreased.4.Correlation of blood pressure change and various data : analysis the correlation between Δi SBP,ni SBP,Δi MAP and clinical data,Δi SBP is positivetively correlated with diabetes,cholesterol,low density lipoprotein,pre-i SBP,heart rate at ni SBP and body weight difference(pre-dialysis-post-dialysis),and negetivetively correlated with total protein,albumin,high-density lipoprotein,serum phosphorus,Ao RD,LVDD and ni SBP(P<0.05);ni SBP is negetivetively correlated with age,age of dialysis,red blood cells count,RDW,Hct,carbon dioxide binding force,heart rate at ni SBP,Δi MAP and history of cardiovascular disease,and positively correlated with triglyceride,pre-i SBP and history of hypertension(P<0.05);Δi MAP is positively correlated with age and female,and negetivetively correlated with ni SBP,ni DBP,ni MAP,total protein,albumin,albumin/globulin ratio and LVDD(P<0.05).Conclusion:1.Advanced age,high ultrafiltration rate,high hs-CRP level is an independent risk factor for the occurrence of IDH.2.Patients with MHD should pay attention to monitoring the nutritional status,blood glucose,blood lipid,iron metabolism and other conditions to better prevent the frequent occurrence of IDH.