| Objective:Comprehensively understand the interdialytic blood pressure rhythm and blood pressure levels of maintenance hemodialysis patients,and analyze the related influencing factors,in order to guide clinical treatment,to improve the survival rate and quality of life of maintenance hemodialysis patients,and to improve their long-term survival and prognosis.Method:106 MHD patients were enrolled in the Department of Nephrology of Second Hospital of Jilin University from November 2017 to November 2018.The clinical data were collected,including: general indicators(gender,age,height,weight,BMI,primary disease,age of dialysis,antihypertensive drugs,presence or absence of diabetes,erythropoietin dosage),laboratory indicators(albumin,hemoglobin,red blood cell distribution width,average red blood cell volume,platelets,serum sodium,serum calcium,serum phosphorus,calcium and phosphorus product,serum magnesium,alkaline phosphatase,parathyroid hormone,triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,?-2 microglobulin),ambulatory blood pressure parameters(24-hour systolic blood pressure(24 h SBP),24-hour diastolic blood pressure(24hDBP),24-hour mean arterial blood pressure(24hMAP),Daytime systolic blood pressure(dSBP),Daytime diastolic blood pressure(dDBP),Daytime mean arterial blood pressure(dMAP),Nighttime systolic blood pressure(nSBP),Nighttime diastolic blood pressure(nDBP),Nighttime mean arterial blood pressure(nMAP),decline rate of nocturnal systolic blood pressure,decline rate of nocturnal diastolic blood pressure,24-hour systolic blood pressure variability,24 hours diastolic pressure variability,daytime systolic blood pressure variability,daytime diastolic blood pressure variability,nighttime systolic blood pressure variability,nighttime diastolic blood pressure variability,Ambulatory Arterial Stiffness Index(AASI)).Thepatients were divided into three groups according to the decline rate of nocturnal systolic blood pressure: dipper group(11 cases),non-dipper group(47 cases),anti-dipper group(48 cases).According to the 2017 European ERA-EDTA/ESH consensus,the patients were divided into normal blood pressure group(21 cases)and Hypertension group(85 cases).The general indicators,laboratory indicators and ambulatory blood pressure parameters of the patients in each of the above two groups were compared,and the influencing factors were analyzed.The data was processed using SPSS 25.0 statistical software.Results:1.Basic characteristics:Among the 106 MHD patients,61 cases were males(57.55%)and 45 cases were females(42.45%),with the average age(57.92±12.54)years,and the average age of dialysis(61.73±47.73)months.The primary disease types include: chronic glomerulonephritis in 32 cases(30.19%),diabetic nephropathy in 29 cases(27.36%),benign hypertensive renal damage in 16 cases(15.09%),polycystic kidney disease in 9 cases(accounting for 8.49%),chronic interstitial nephritis in 6 cases(5.66%),nephrotic syndrome in 3 cases(2.83%),malignant hypertensive renal damage in 2 cases(1.89%),transplanted kidney failure in 2cases(1.89%),gouty nephropathy in 1 case(0.94%),ANCA-related renal damage in1 case(0.94%),unknown cause in 5 cases(4.72%).2.Comparison of general indicators according to blood pressure rhythm: dipper blood pressure rhythm:11 cases(10.38%),non-dipper blood pressure rhythm: 47cases(44.34%),anti-dipper blood pressure rhythm:48 cases(45.28%),abnormal blood pressure rhythm accounted for 89.62%.In patients with hypertension,abnormal blood pressure rhythm accounted for 91.77%,and abnormal blood pressure rhythm without hypertension may account for 80.95%.The age and erythropoietin dosage were statistically significant among the three groups(P=0.009 and 0.028).Further pairwise comparison which were performed among groups showed that the age of the anti-dipper group was higher than the dipper group(P=0.009).The erythropoietin dosage in the anti-dipper group was higher than that in the non-dipper group(P=0.015),and the difference was statistically significant.3.Comparison of laboratory indicators according to blood pressure rhythm:albumin,hemoglobin,serum phosphorus,calcium and phosphorus,parathyroid hormone,?2-microglobulin were significantly different between the three groups(P=0.045,P=0.005,P=0.001,P=0.004,P=0.003,P=0.041).Further pairwise comparison which were performed among groups,the level of albumin in the anti-dipper group was lower than that in the dipper group(P=0.016).The hemoglobin in the anti-dipper group was lower than that in the non-dipper group,and the difference was statistically significant(P =0.005);the serum phosphorus,calcium and phosphorus product,and parathyroid hormone were higher in the non-dipper group and the anti-dipper group than in the dipper group,the difference was statistically significant(P < 0.0167);the anti-dipper group ?2-The microglobulin was higher than the dipper group,and the difference was statistically significant(P=0.003).4.Comparison of blood pressure parameters according to blood pressure rhythm: 24 hSBP,dSBP,nSBP,nDBP,nMAP,AASI were significantly different among the three groups(P=0.002,P=0.021,P<0.0001,P=0.001,P<0.0001,P=0.046).Further pairwise comparison which were performed among groups revealed that the 24 hSBP and dSBP of the dipper group were lower than the anti-dipper.The difference was statistically significant(P=0.002,P=0.008).The nSBP and nMAP of the dipper group were lower than those of the non-dipper group and the anti-dipper group,and the non-dipper group was lower than the anti-dipper group.The difference was statistically significant(P<0.0167);the nDBP of the dipper group was lower than the non-dipper group(P=0.001);the AASI of the dipper group was lower than theanti-dipper group,the difference was statistically significant(P=0.013).5.Analysis of influencing factors of blood pressure rhythm:(1)Univariate analysis: decline rate of nocturnal systolic blood pressure was negatively correlated with age(r=-0.265,P=0.006),serum phosphorus(r=-0.251,P=0.010),parathyroid hormone(r=-0.223,P=0.025),?2 microglobulin(r=-0.300,P=0.002),erythropoietin dosage(r=-0.263,P=0.006),Ambulatory Arterial Stiffness Index(r=-0.225,P =0.006),and positively correlated with albumin(r=0.216,P=0.032),hemoglobin(r=0.246,P=0.011),and high-density lipoprotein(r=0.202,P=0.040).(2)Multivariate analysis:decline rate of nocturnal systolic blood pressure was independently associated with albumin,serum phosphorus,?2-microglobulin,erythropoietin dosage,and decline rate of nocturnal systolic blood pressure was positively correlated with albumin(?=0.376,P=0.042),and negatively correlated with serum phosphorus(?=-3.930,P=0.012),?2-microglobulin(?=-0.349,P=0.002),erythropoietin dosage(?=-0.037,P=0.031).6.Comparison of general indicators according to blood pressure level: 21 cases(19.81%)in the normal blood pressure group and 85 cases(80.19%)in the hypertension group,of which 21 cases blood pressure were controlled below 130/80 mmHg.The blood pressure control rate only accounted for 24.71%.In the hypertension group,72 patients took antihypertensive drugs,and the treatment rate was 84.71%.The age of dialysis of the hypertension group was lower than that of the normal blood pressure group,and the difference was statistically significant(P<0.0001).7.Comparison of laboratory indicators according to blood pressure level:The red blood cell distribution width in the hypertension group was higher than that in the normal blood pressure group,and the difference was statistically significant between the two groups(P=0.020).8.Comparison of blood pressure parameters according to blood pressure level:The AASI of the hypertension group was higher than that of the normal blood pressure group,and the difference between the two groups was statistically significant(P=0.042).9.Analysis of influencing factors of blood pressure level: Increased age of dialysis is a negative correlation factor for interdialytic elevated blood pressure levels in maintenance hemodialysis patients(OR=0.984,P=0.037).conclusion:1.Abnormal blood pressure rhythm is common for maintenance hemodialysis patients in the interdialysis period.The abnormal blood pressure rhythm is mainly characterized by non-dipper and anti-dipper.It is high for maintenance hemodialysis patients in the interdialysis period that the incidence of hypertension,but the treatment and control rate are poor.2.During the dialysis interval,the erythropoietin dosage,serum phosphorus and?2-microglobulin are significantly negatively correlated with the decline rate of nocturnal systolic blood pressure,which are independent risk factors for interdialytic abnormal blood pressure rhythm in maintenance hemodialysis patients;albumin is significantly positively correlated with the decline rate of nocturnal systolic blood pressure,and it is an independent protection factor for interdialytic blood pressure rhythm in maintenance hemodialysis patients.3.Increased age of dialysis is a negative correlation factor for interdialytic elevated blood pressure levels in maintenance hemodialysis patients. |
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