| Objectives:Hypotension on hemodialysis is the most common complication in hemodialysis patients and is associated with cardiovascular events and higher mortality in patients with chronic kidney disease.Its early prevention will significantly improve the quality of life of patients with end-stage renal disease.Limb ischemia preconditioning is commonly used in patients with non-dialysis chronic kidney disease and has a certain cardiovascular protective effect,but the effect on IDH is unclear.Therefore,this study explored the efficacy and safety of LIPC in patients with maintenance hemodialysis IDH by measuring blood pressure and blood indicators before and after LIPC intervention and analyzing the results.Methods:This was a prospective,randomized,single-center controlled study.A total of 38 patients with maintenance HD who met the inclusion criteria from January 2021 to December 2021 from January 2021 to December 2021 were selected as the study subjects,and randomly divided into LIPC group(n=19)and control group(n=19)by random number table method,and the LIPC group was pressurized with a LIPC trainer to compress the middle and upper thigh of the patient(left or right)for 5 minutes(200mm Hg)before each HD,and then relaxed for 5 minutes(0 mm Hg)and repeated 5 times.50 minutes in total.The control group was pressurized to 20 mm Hg with a LIPC instrument,and the rest was the same as the LIPC group.The blood pressure of 0h,1h,2h,3h,4h and body weight before and after dialysis of HD in the two groups were measured,the ultrafiltration volume and ultrafiltration rate were recorded,and the incidence of IDH,clinical treatment and early termination of HD in the two groups were observed,the adverse events that occurred during the LIPC intervention,and the changes of serum troponin I and creatine kinase isoenzyme MB before and after the intervention.Differences between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between blood pressure changes before and after the intervention and TNI and CK-MB interventions.Results :1.We recruited a total of 101 patients with hypotension on maintenance hemodialysis,of whom 58 were eligible for inclusion,and 20 patients automaticall withdrew from the trial because they could not follow the standard trial protocol before the trial,and finally 38 patients completed the entire trial.The average age of patients in the LIPC group was 56.9 years,male patients accounted for 57.9%,and the average age of patients in the control group was 57.5 years,male patients accounted for 52.6%.Compared with the control group,there were significant differences in serum calcium in the LIPC group(2.2±0.2mmol/d L vs 2.3±0.2mmol/d L,t=2.61,P=0.03),there were no significant differences in phosphorus,PTH,hemoglobin,albumin,blood lipids and other indexes between the two groups(P > 0.05),and there were no significant differences in comorbidities,drug use and blood pressure before intervention(P > 0.05).2.The incidence of mean arterial pressure of 1h,2h,3h,and 4h in the two groups:the mean arterial pressure at 3 h in the LIPC group at weeks 8 and 12 after intervention was higher than that in the control group,and the comparison between the two groups was statistically significant(8 weeks: 103.28±12.19 mm Hg vs 93.18±11.11 mm Hg,P=0.04;12 weeks: 101.81±11.36 mm Hg vs 91.81±11.92 mm Hg,P=0.047);The mean arterial pressure at 4 h at weeks 8 and 12 after intervention was higher in the LIPC group than in the control group,and the comparison between the two groups was statistically significant(8 weeks: 105.09±13.32 mm Hg vs 94.47±11.35 mm Hg,P=0.048;12 weeks: 103.77±10.09 mm Hg vs 92.81±14.56 mm Hg,P=0.04),the remainder were not statistically significant.3.Comparison of IDH occurrence,clinical intervention,and early termination of HD between the two groups: The incidence of IDH in the LIPC group was statistically significantly lower than that in the control group(36.5% vs 43.1%,P=0.01).Compared with the control group,the rates of clinical intervention and early termination of HD in patients with IDH in the LIPC group were lower and statistically significant clinical intervention: 6.3% vs 12.4%,P=0.00;HD early termination: 1.6% vs 3.8%,P=0.01).4.Changes of TNI and CK-MB between LIPC and control before and after intervention: there were no significant differences in serum TNI and CK-MB levels between the two groups before intervention(TNI: 440.41±17.79ng/d L vs435.87±16.23ng/d L,P=0.28;CK-MB: 205.63 ± 7.46 U/d L vs 205.29 ±7.78 U/d L,P=0.82),TNI and CK-MB in the LIPC group were lower than those in the control group at 12 weeks after the intervention,which was statistically significant(TNI:323.09±13.50ng/d L vs 438.50±24.72ng/d L,P<0.01;CK-MB: 159.01±8.49U/d L vs207.00±8.70U/d L,P<0.01)。5.Correlation analysis of mean arterial pressure with TNI and CK-MB(TNI :r=-0.473,P=0.041;CK-MB,: r=-0.469,P=0.043).6.Changes in dry body mass and UF rate between LIPC group and control group before and after intervention: There were no significant differences in dry body weight and UF rate between the two groups before intervention [63.67(57.19-70.16)kg vs63.04(56.53-69.55)kg,P=0.96;10.18±1.99 m L/kg/h vs 9.15±2.66ml/kg/h,P=0.19],there were still no significant differences in dry body weight and UF rate between the two groups at 12 weeks after intervention [ 63.94(57.39-70.48)kg vs 64.11(57.50-70.71)kg,P=0.86;9.25±1.91ml/kg/h vs 9.22±2.15ml/kg/h,P=0.97].7.LIPC related adverse events: patients tolerated the LIPC autotrainer well,and no patient withdrew from the trial due to pain or other related discomfort during LIPC.Conclusion:1.LIPC can effectively reduce the incidence of IDH in MHD patients,and reduce the occurrence of clinical intervention and early termination of HD.2.The change value of MAP after LIPC intervention was negatively correlated with CK-MB and TNI,suggesting that the reduction of myocardial injury by LIPC was associated with the reduction of the incidence of IDH.3.LIPC is safe and non-invasive,simple and feasible,in addition,it is well tolerated by patients,and no significant adverse reactions were observed during the test.LIPC can be used in patients with IDH. |
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