Evaluation And Significance Of Bioelectrical Impedance Combined With Echocardiography On Blood Pressure Fluctuation In Hemodialysis Patients During Dialysis

Objective To explore the correlation between blood pressure fluctuation and volume load management and cardiac function in patients with maintenance hemodialysis(MHD).Bioresistive method was used to evaluate the state of adjusted volume load after the setting of the target body mass.Combined with echocardiography,factors affecting blood pressure fluctuation before and after hemodialysis in MHD patients were evaluated.Methods A total of 73 MHD patients were enrolled in the hemodialysis Center of Baotou Central Hospital from September 2021 to September 2022.According to the difference between postdialysis and pre-dialysis systolic blood pressure(SBP)of MHD patients,the patients were divided into three groups.Among them,the group with high fluctuating blood pressure(△SBP≥10mm Hg,23 cases),the group with stable blood pressure(-20 mm Hg<△SBP<10mm Hg,30 cases)and the group with low fluctuating blood pressure(△SBP≤-20 mm Hg,20 cases).General clinical data,blood pressure during dialysis and treatment parameters of enrolled patients were collected.The overhydrtion(OH)and other volumetric load indexes of the three groups of MHD patients were measured by bioresistive method before and after dialysis.The dry body mass of the three groups of MHD patients was gradually adjusted to reach the standard for 6 months according to the water load OH value detected by bioelectrical impedance.The blood pressure changes of the three groups of MHD patients during dialysis were monitored.At the same time,echocardiography was used to assess the cardiac structure and function status of the patients,including valve calcification,the results of relevant laboratory biochemical tests and the use of drugs that affect blood pressure fluctuations were collected,and the changes of household blood pressure in MHD patients during non-dialysis period were monitored.Blood pressure fluctuation,water load index,cardiac structure and function status,and biochemical index were statistically compared in 3 groups of MHD patients before and after dialysis.Taking OH value of water load as the main capacity load index,the correlation between this index and other detection indexes was analyzed.Results(1)There were 21 cases in the decreased blood pressure fluctuation group,29 cases in the stable blood pressure group,and 23 cases in the increased blood pressure group.There were no significant differences in age,dialysis age,cardiovascular disease,diabetes,antihypertensive drugs and other drugs that may affect blood pressure among the three groups(P>0.05).Before adjusting dry body mass,the serum albumin in the increased blood pressure fluctuation group was significantly lower than that in the decreased blood pressure fluctuation group(P<0.05).(2)SBP and diastolic blood pressure(DBP)before dialysis were lower than those in the other two groups,and SBP after dialysis was higher than those in the other two groups,with statistical significance(P<0.001).SBP after dialysis was lower than that before adjustment.The difference was statistically significant(P<0.001),and the difference of SBP blood pressure before and after dialysis was significantly reduced in the group with increased blood pressure fluctuation after adjustment.Both SBP and DBP in the blood pressure fluctuation reduction group before adjustment of dry body mass were higher than those in the other two groups,with statistical significance(P<0.001);SBP before adjustment of dialysis was lower than that before adjustment,with statistical significance(P<0.001);the blood pressure difference before and after adjustment of SBP fluctuation reduction group was significantly reduced.(3)Before adjusting dry body mass,there were no significant differences in OH value,TBW,ECW and ICW before dialysis among the three groups(P>0.05),and OH value after dialysis in the group with increased blood pressure fluctuation was still higher than that in the other two groups,with statistical significance(P<0.05).After the adjustment of dry body mass,TBW of the three groups before dialysis decreased,respectively,and the difference was statistically significant(P<0.05).After dry body mass adjustment,ECW before dialysis in the group with increased blood pressure fluctuation was lower than that before adjustment,the difference was statistically significant(P<0.05),while TBW after dialysis in the group with stable blood pressure and the group with decreased blood pressure fluctuation was lower than that before adjustment,the difference was statistically significant(P <0.05).(4)Before dry body mass adjustment,the ultrafiltration volume in the increased blood pressure group was significantly lower than that in the other two groups,with statistical significance(P<0.05).(5)Before the adjustment of dry body mass,there were no significant differences in the levels of echocardiography RA,LAD,RV,LVEF,LVDd,LVPWd and CVC among the three groups(P>0.05).After the adjustment of dry body mass,RA,LAD and LVDd in the group with increased blood pressure fluctuation were all lower than before,while LVEF was higher than before.The difference was statistically significant(P<0.05).There was no significant difference in RA,LAD,RV,LVDd and LVPWd in the decreased blood pressure fluctuation group compared with before adjustment(P>0.05),but LVEF was higher than that before adjustment(P<0.05).There was no significant difference in CVC among the three groups compared with before adjustment(P>0.05).Conclusion 1.The study found that the increased blood pressure fluctuation group of MHD patients was related to the pre-dialysis volume overload state,low ultrafiltration volume and low albumin level,and the reduced blood pressure fluctuation group was related to the small volume load and high ultrafiltration volume before dialysis.2.Blood pressure analysis of the three groups of MHD patients found that high SBP before dialysis and high DBP before dialysis were risk factors for the decrease of blood pressure fluctuation during dialysis,while low SBP before dialysis and low DBP before dialysis were risk factors for the increase of blood pressure fluctuation during dialysis.3.The volume load status of MHD patients was monitored by bioresistive method.Long-term volume load management could reach the standard of dry body mass,which was conducive to reducing blood pressure fluctuations during dialysis,improving cardiac function status and increasing ejection fraction of MHD patients.