Effect of post-dialysis blood pressure on long-term survival prognosis of maintenance hemodialysis patients
10.3760/cma.j.cn441217-20240220-00225
- VernacularTitle:透析后血压对维持性血液透析患者长期生存预后的影响
- Author:
Congfei WANG
1
;
Bin PAN
;
Xishao XIE
;
Chunping XU
;
Jianghua CHEN
;
Ping ZHANG
Author Information
1. 浙江大学医学院附属第一医院肾脏病中心 浙江省透析质量控制中心，杭州 310003
- Keywords:
Hemodialysis;
Blood pressure;
Survival rate;
Post-dialysis blood pressure;
All-cause mortality rate
- From:
Chinese Journal of Nephrology
2024;40(10):780-791
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the impact of post-dialysis blood pressure (Post-BP) on the long-term survival prognosis of maintenance hemodialysis (MHD) patients and the related risk factors.Methods:It was a retrospective cohort study. The data of patients who underwent their first hemodialysis (HD) from January 1, 2007, to June 30, 2021, as recorded in the dialysis registration system of the Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine was retrospectively analyzed. The mean Post-BP was calculated for each HD session 4-6 months after hemodialysis. According to the mean value of post-dialysis diastolic pressure (Post-DBP) at 4-6 months after dialysis, patients were divided into 3 groups (Post-DBP<80 mmHg, 80 mmHg≤Post-DBP<90 mmHg, Post-DBP≥90 mmHg). According to whether the mean value of post-dialysis systolic pressure (Post-SBP) was ≥140 mmHg and whether the mean value of Post-DBP was ≥80 mmHg, patients were divided into 4 groups (Post-SBP<140 mmHg, Post-DBP≥80 mmHg; Post-SBP≥140 mmHg, Post-DBP≥80 mmHg; Post-SBP<140 mmHg, Post-DBP<80 mmHg; Post-SBP≥140 mmHg, Post-DBP<80 mmHg). Patients' first dialysis time was used as the starting point of follow-up, and the end point of follow-up was death or conversion to peritoneal dialysis or kidney transplantation or up to December 31, 2021. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression model were used to analyze the relationship between Post-BP and survival rate and the related factors of prognosis in MHD patients.Results:According to inclusion criteria, a total of 1 213 patients were included. Kaplan-Meier survival curve showed that the long-term survival rate had statistically significant differences among Post-DBP<80 mmHg, 80 mmHg≤Post-DBP<90 mmHg and Post-DBP≥90 mmHg groups (Log-rank test, χ2=58.838, P<0.001), and Post-DBP<80 mmHg group was the lowest. Further comparing the cardiovascular diseases (CVD) mortality among the three groups, the curve showed a statistically significant difference (Log-rank test, χ2=27.926, P< 0.001), and the highest CVD mortality was found in the Post-DBP<80 mmHg group. Multivariate Cox regression model analysis showed that Post-DBP<80 mmHg was an independent associated factor for death in MHD patients (with Post-DBP mmHg≥90 group as reference, HR=4.197, 95% CI 1.452-12.197, P=0.008). When patients were divided into 4 groups according to whether the mean value of Post-SBP was ≥140 mmHg and whether the mean value of Post-DBP was ≥80 mmHg, Kaplan-Meier survival analysis showed a statistically significant difference in long-term survival rate among the four groups (Log-rank test, χ2=65.636, P<0.001), among which Post-SBP≥140 mmHg, Post-DBP<80 mmHg group had the lowest long-term survival rate. Further comparing the CVD mortality rate among the four groups, the curve showed a statistically significant difference (Log-rank test, χ2=29.784, P<0.001), and the highest CVD mortality rate was found in the Post-SBP≥140 mmHg, Post-DBP<80 mmHg group. Multivariate Cox regression analysis revealed that regardless of whether the average Post-SBP was ≥140 mmHg, Post-DBP<80 mmHg was an independent associated factor for death in MHD patients(with Post-SBP<140 mmHg, Post-DBP≥80 mmHg group as reference, Post-SBP≥140 mmHg, Post-DBP<80 mmHg group: HR=3.416, 95% CI 1.294-9.019, P=0.013; Post-SBP<140 mmHg, Post-DBP<80 mmHg group: HR=3.574, 95% CI 1.451-8.802, P=0.006). Conclusions:The long-term survival rate of the group with Post-SBP≥140 mmHg and Post-DBP<80 mmHg is significantly lower. Post-DBP<80 mmHg is an independent risk factor for death in MHD patients regardless of whether the average Post-SBP is ≥140 mmHg.
