The Influence Factors Of Intradialytic Blood Pressure Changes In Maintenance Hemodialsyis Patients

Background:Cardiovascular disease is the leading cause of death in maintenance hemodialsyis(MHD) patients,accounting for more than a half of deaths.Significant controversy surrounds the issue of hypertension and outcomes among hemodialysis (HD) patients.Most readily available BP parameters(HD unit) correlate poorly with interdialytic hemodynamic burden.Intradialytic Bp changes are associated with outcomes.Objectives:To assess the relationship between blood pressure changes with hemodialysis and find some related factors.Methods:247 patients who undergoing MHD were enrolled in this cross sectional study.For the purpose of this study,subjects were divided a priori into three clinical groups based on BP changes with HD:(1) BP rose with HD(△SBP≥10mmHg),(2) BP unchanged with HD(—10mmHg＜△SBP＜10mmHg),and(3) BP fell with HD (△SBP≤—10mmHg).The statistics covariates include demographic data,tobacco use,dialysis prescription,dialysis access type,past medical history,cause of ESRD, hypertension,coronary artery disease,congestive heart failure,left ventricular hypertrophy,cerebrovascular disease,arrhythmia,laboratory examinations, antihypertensive medication class,Erythropoiesis stimulating agent(ESA) use and so on.Describe clinical differences between patients based on BP responses to HD.Logistic regression were performed to sort out the predicting factors of intradialytie BP changes.Results:143 subjects(57.9%) had a fall in SBP associated with HD(△SBP≤—10mmHg),79 subjects(31.98%) did not have a significant change in SBP from pre- to post-HD(—10mmHg＜△SBP＜10mmHg),and 25 subjects(10.12%) exhibited a paradoxical rise in SBP with HD(△SBP≥10mmHg).The incidence of hypertension history,post-SBP,post-DBP,the percentage of ESA use,BP not well controlled andβblockers use in BP rose group were significantly higher than those in BP unchanged group and BP fell group(P<0.05).frequency of HD,Hb,serum albumin were significantly lower than those in BP fell group(P<0.05).The incidence of the aged,the quantity of antihypertensive medication in BP unchanged group were significantly higher than those in BP rose group and BP fell group(P＜0.05).The incidence of year for dialysis＞1 year and IDWG,IDWG%,ultrafiltration rate,pre-SBP,pre-DBP, ejection fraction in BP fell group were significantly higher than those in BP rose group and BP unchanged group(P＜0.05).The difference of Gender,cause of ESRD, tobacco use,dry bodyweight,BMI,diabetes mellitus history dialysis access type,coronary artery disease,congestive heart failure,left ventricular hypertrophy, cerebrovascular disease,arrhythmia,ESA doses,Hb,BUN,Cr,sodium,potassium, calcium,phosphorusp,iPTH,URR,Kt/V,the percentage of CCB,ACEI,ARB,αblockers and diuretics use among three groups were not significant.In Logistic regression analysis,post-BP rose with HD(△SBP≥10mmHg)was presented the positive correlation with ESA use(OR=10.144,P=0.032),while post-BP rose with HD shown the negative correlation with Hb(OR=0.972,P= 0.033),serum albumin(OR=0.002,P=0.018),ultrafiltration rate(adjusted by EDW) (OR=0.855,P=0.022);Post-BP fell with HD(△SBP≤—10mmHg) shown the positive correlation with Hb(OR=1.026,P=0.003),IDWG%(OR=1.833E15, P=0.000).Conclusion:Intradialytic blood pressure changes were influenced by many factors,include age,year for dialysis,hypertension history,IDWG,IDWG%, ultrafiltration rate,frequency of HD,pre-SBP,pre-DBP,post-SBP,post-DBP,ESA use, Hb,serum albumin and so on.The influencing factors of post-BP rose with HD are ESA use,Hb,serum albumin,ultrafiltration rate(adjusted by EDW).The influencing factors of post-BP fell with HD are Hb,IDWG%.