Blood Pressure Characteristics And Influencing Factors On Intradialysis And Interdialysis In Maintenance Hemodialysis Patients

Objective The purpose of this study was to investigate the 48 h ambulatory blood pressure characteristics of maintenance HD patients during the dialysis period and the interdialysis period,and then analyze the possible influencing factors,so as to better manage the blood pressure of HD patients.Methods A total of 50 HD patients who underwent maintenance HD treatment in hemodialysis center of Zhejiang provincial people's hospital from 2017 to 2018 and met the inclusion and exclusion criteria of this study were collected,during the experiment,20 subjects could not complete the experiment,and finally,the age,gender,diabetes history,dialysis age,dialysis mode,antihypertensive drugs,recombinant human erythropoietin injection,HB,Alb,BUN,Scr,K,Na,Ca,P,Mg,TC,TG,iPTH,HDL,LDL,aortic diameter,left atrium,right ventricular size,E peak /A peak,ejection fraction,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,ventricular septal thickness,left ventricular posterior wall thickness of 30 patients with maintenance HD were analyzed.By means of ambulatory blood pressure recorder,the ambulatory blood pressure data of the included population for 48 hours were obtained,and the data were collated and statistically analyzed.According to whether the 24 h blood pressure pattern changed before and after,it was divided into two groups,namely the stable blood pressure pattern group and the deteriorating blood pressure pattern group.SPSS 22.0 software was used for statistical analysis of the above results.Results1.The average age of the 30 patients with maintenance HD was 60.67±14.2 years,the average dialysis age was 29.93±23.53 months,the average HB was 103.87±10.82g/L,and the average Alb was 38.04±4.34g/L,internal fistula was the main dialysis method,and CCB drugs were the main antihypertensive drugs(70%).2.The mean SBP at 2 weeks before the test was moderately correlated with the mean SBP at 48 h during the day(r=0.48).It was correlated with the mean SBP at 48h(r=0.38).It was moderately correlated with SBP in the first 24 hours of daytime(r=0.46).It was moderately correlated with SBP 24 hours before night(r=0.43).It was associated with moderate SBP at 24 h after day(r=0.37).The mean SBP at 2 weeks before the experiment was moderately correlated with the mean SBP at 48 h after the experiment(r=0.51).It was correlated with the mean SBP at 24h(r=0.53).The mean DBP at 2 weeks before the experiment was highly correlated with the mean DBP at48h(r=0.86).It was highly correlated with the average DBP at 48h(r=0.77).It was highly correlated with the first 24 hours of daytime DBP(r=0.88).It is highly correlated with DBP at night after 24h(r=0.67).The mean DBP at 2 weeks before the experiment was highly correlated with the mean DBP at 48 h after the experiment(r=0.77).It was highly correlated with the average DBP at 48h(r=0.65).It was highly correlated with the first 24 hours of daytime DBP(r=0.77),It is highly correlated with DBP at night after24h(r=0.56).3.30 patients with maintenance HD had an average SBP 155.53±17.41 mmHg at 48 h,SBP 154.70 ±16.71 mmHg at 24 h,SBP 156.97±21.35 mmHg at 24 h,SBP155.53±17.00 mmHg at 48 h,SBP 155.07±16.16 mmHg at 24 h,SBP 156.50±19.70 mmHg at 24 h.SBP 154.80±20.50 mmHg at night at 48 h,SBP 156.00±21.31 mmHg at24h,SBP 156.73±24.62 mmHg at 24 h.After 24 h,SBP and DBP in daytime and at night were higher than those before 24 h.4.The diurnal blood pressure rhythm of 30 patients with maintenance HD in the first 24 hours was the same as that of the non-non-spoon type and the reverse spoon type,accounting for 43.3%,and 10% spoon type.The circadian rhythm of blood pressure after 24 h was 36.67% for non-spoon type,46.67% for reverse spoon type,and 16.67%for spoon type.Compared with the 24 h blood pressure circadian rhythm,the 24 h blood pressure circadian rhythm changed in 60% of patients with maintenance HD.5.There was no significant difference in age,dialysis age,history of diabetes,ultrafiltration,HB,Alb,K,Ca,Mg,P,iPTH between the two groups(p>0.05),but the difference of serum Na concentration was statistically significant(p=0.02).There was a statistically significant difference in SBP between the two groups during the first 24 h at night(p=0.02).There were no statistically significant differences in mean SBP/DBP/HR(48h,24 h before and 24 h after)during the day and mean SBP/DBP/HR(48h,24 h before and 24 h after)during the night.There were statistically significant differences between the two groups in peak E /A(p=0.026)and peak EF(p=0.035).The48 h SBP/DBP/HR/MAP in the blood pressure model variation group showed significant fluctuations in the overall trend.Conclusions The circadian rhythm of blood pressure in maintenance HD patients was mainly non-spoon type and reverse spoon type,and showed obvious instability.For maintenance HD patients,48 h ABPM can more comprehensively assess the patient's blood pressure,especially systolic blood pressure.The decreased blood pressure pattern in maintenance HD patients may be related to serum sodium concentration and cardiac systolic and diastolic functions.In HD patients with poor blood pressure patterns,blood pressure fluctuates significantly and may be more difficult to manage.