老年维持性血液透析病人透析中发生低血压的危险因素研究

doi:10.3969/j.issn.1003-9198.2024.06.003

摘要/Abstract

摘要： 目的分析老年维持性血液透析病人透析中发生低血压的危险因素。方法回顾性分析东南大学附属中大医院江北院区血液净化中心2022年6月至2023年6月老年透析病人的临床资料,包括一般资料、透析中低血压发生情况、临床相关实验室指标。应用Logistic回归分析血液透析中低血压的相关危险因素,绘制ROC曲线探讨相关因素预测低血压发生的效能。结果共纳入128例老年病人,共计透析8766例次,其中52例老年病人共计发生了682例次透析中低血压,发生率为7.78%。根据有无发生透析中低血压分为透析中低血压组和未发生组,Logistic回归分析显示,血管通路方式为长期导管(OR=7.94,95%CI:2.76~22.87,P＜0.001)以及超滤速率＞8.8 mL/min(OR=5.40,95%CI:1.55~18.75,P=0.008)是透析中发生低血压的危险因素。ROC曲线分析显示超滤速率预测透析中发生低血压的曲线下面积(AUC)为 0.712,约登指数为0.357,最佳截断值为9.0 mL/min,灵敏度为67.3%,特异度为68.4%。结论血管通路为长期导管、超滤速率＞8.8 mL/min是老年透析病人透析中发生低血压的危险因素,超滤速率对老年病人透析中发生低血压具有一定的预测价值。

关键词: 血液透析, 低血压, 老年人, 危险因素

Abstract: Objective To analyze the risk factors for the occurrence of intra-dialytic hypotension (IDH) in the elderly patients undergoing maintenance hemodialysis (MHD). Methods The clinical data of the elderly MHD patients in Blood Purification Center of Zhongda Hospital Southeast University from June 2022 to June 2023 were retrospectively collected and analyzed, including general data, incidence of dialysis-related hypotension and laboratory indicators. Logistic regression was used to analyze hypotension-related risk factors in hemodialysis, and ROC curve was drawn to explore the predictive value of hypotension-related factors. Results A total of 128 elderly patients were enrolled, of which 52 elderly patients presented with a total of 682 times of IDH, with an incidence rate of 7.78%. According to the occurence of IDH, all the patients were divided into IDH group and non-IDH group, and Logistic regression analysis showed that long-term catheter (intra-arteriovenous fistula as reference, OR=7.94, 95%CI: 2.76-22.87, P <0.001), ultrafiltration rate＞8.8 mL/min (≤8.8 mL/min as reference, OR=5.40, 95%CI: 1.55-18.75, P=0.008) were independently associated with IDH. ROC curve analysis showed that the area under the curve (AUC) of the ultrafiltration rate predicting IDH was 0.712, Youden index was 0.357, the optimal cut-off value was 9.0 mL/min, the sensitivity was 67.3% and the specificity was 68.4%. Conclusions Long-term catheter access and ultrafiltration rate > 8.8 mL/min are risk factors for IDH in the elderly MHD patients. Ultrafiltration rate has certain predictive value for IDH in elderly MHD patients.

Key words: hemodialysis, hypotension, aged, risk factors

中图分类号:

R473.5

闫小红, 谢庆磊, 王越, 周宏云. 老年维持性血液透析病人透析中发生低血压的危险因素研究[J]. 实用老年医学, 2024, 38(6): 549-552.

YAN Xiaohong, XIE Qinglei, WANG Yue, ZHOU Hongyun. Study on risk factors of intra-dialytic hypotension in elderly patients undergoing maintenance hemodialysis[J]. Practical Geriatrics, 2024, 38(6): 549-552.

参考文献

[1] 肾脏病医疗质控中心.血液净化标准操作规程(2021)[S].国家卫生健康委办公厅,2021:203.
[2] LOCATELLI F, ALTIERI P, ANDRULLI S, et al. Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD [J]. J Am Soc Nephrol, 2010, 21(10):1798-1807.
[3] 中国医药教育协会肾病与血液净化专业委员会血液透析低血压防治专家组.血液透析中低血压防治专家共识(2022)[J].中华内科杂志,2022,61(3):269-281.
[4] GUL A, MISKULIN D, HARFORD A, et al. Intradialytic hypotension[J]. Curr Opin Nephrol Hypertens, 2016, 25(6):545-550.
[5] FLYTHE J E, CHANG T I, GALLAGHER M P, et al. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference[J]. Kidney Int, 2020, 97(5):861-876.
[6] 曹虎男,刘玉秀,樊蕊,等.老年维持性血液透析患者透析中低血压的危险因素分析[J]. 中华肾脏病杂志,2023,39(2):101-111.
[7] 张晓玲,白久旭,郝峻烽,等.老年维持性血液透析患者血管钙化与透析间低血压的相关性研究[J].中华保健医学杂志,2017,19(6): 492-495.
[8] LOK C E, HUBER T S, LEE T, et al.KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update[J]. Am J Kidney Dis, 2020, 75(4):S1-S164.
[9] 费世枝,熊飞,李红兵,等. 2018年度武汉地区老年维持性血液透析患者血管通路调查分析[J].临床肾脏病杂志,2020,20(7):551-556.
[10] 黄玉萍,徐辉,王道洋,等. 蚌埠地区老年维持性血液透析患者血管通路调查分析[J].中国血液净化,2021,20(12):835-838.
[11] 傅华珍,丁小容,陈丹,等.基于随机森林算法的糖尿病肾病患者血液透析中发生低血压预测模型的建立[J].中国中西医结合肾病杂志,2023,24(6):493-496.
[12] SABRY A A, ELSHAFEY E M, ALSARAN K, et al. The level of C-reactive protein in chronic hemodialysis patients:a comparative study between patients with noninfected catheters and arteriovenous fistula in two large Gulf hemodialysis centers[J]. Hemodial Int, 2014, 18(3):674-679.
[13] SACHDEVA M,HUNG A,KOVALCHUK O,et al. The initial vascular access type contributes to inflammation in incident hemodialysis patients[J]. Int J Nephrol, 2012,2012:917465.
[14] 焦占峰,张宜明,马小芬,等.不同超滤率对糖尿病肾病患者维持性血液透析中低血压及心血管死亡发生率影响[J]. 临床军医杂志,2021,49(9):1002-1004.
[15] 王质刚. 血液净化学[M]. 2版,北京:北京科学技术出版社, 2003:171.