糖尿病患者血液透析中低血压的影响因素分析

The influencing factors for intradialytic hypotension in diabetic patients with maintenance hemodialysis

目的探讨糖尿病患者透析中低血压(intradialytic hypotension,IDH)的影响因素。方法选择2017年1月~2019年12月北京3家血液透析中心的糖尿病患者140例,根据IDH的发生频率是否超过30%分为IDH组和非IDH组,记录患者的临床资料,分析2组患者IDH的影响因素。结果IDH组101人,非IDH组39人。Logistic回归分析显示超滤率、透析前收缩压是IDH的独立影响因素,OR值和95%CI:分别为:1.229(1.017~1.487),P=0.033;1.048(1.013~1.083),P=0.007。ROC曲线预测IDH,透析前收缩压的阈值为159mmHg(1mmHg=0.133kPa)(AUC=0.702,95%CI:0.604~0.801,P<0.001);超滤率的阈值为9.5ml/(h·kg)(AUC=0.657,95%CI:0.551~0.762,P=0.004)。结论超滤率、透析前收缩压是糖尿病患者发生IDH的危险因素,建议透析前收缩压质量控制的上限阈值为159mmHg,超滤率的质量控制上限阈值为9.5ml/(h·kg)。

Objectives To explore the influencing factors for intradialytic hypotension(IDH)in diabetic patients with maintenance hemodialysis(MHD).Methods A total of 140 diabetic patients on MHD during January 2017 to December 2019 were recruited from three hemodialysis centers in Beijing.They were divided into two group:IDH group(IDH episodes in more than 30%of dialysis sessions),and non-IDH group(IDH episodes in less than 30%dialysis sessions).Their clinical and laboratory data were collected and the potential impact factors for IDH were evaluated.Results There were 101 cases in IDH group and 39 case in non-IDH group.Logistic regression analysis showed that ultrafiltration rate(OR=1.229,95%CI 1.017~1.487,P=0.033)and pre-hemodialysis systolic blood pressure(OR=1.048,95%CI 1.013~1.083,P=0.007)were the independent influencing factors for IDH.ROC for the prediction of IDH demonstrated that the threshold of pre-hemodialysis systolic blood pressure was 159mmHg(AUC=0.702,95%CI 0.604~0.801,P<0.001)and the threshold of ultrafiltration rate was 9.5ml/h/kg(AUC=0.657,95%CI 0.551~0.762,P=0.004).Conclusions Pre-hemodialysis systolic blood pressure and ultrafiltration rate were the risk factors for IDH in diabetic patients with MHD.