长透析间期前增加超滤率与维持性血液透析患者住院风险的相关性  

Association between increasing ultrafiltration rate before a long interdialytic interval and hospitalization risk in maintenance hemodialysis patients

作　　者：莫江彬 钱捷[1] 梁敏灵[1] 梁波[1] Mo Jiangbin;Qian Jie;Liang Minling;Liang Bo(Department of Nephrology,Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院肾内科,广州510150

出　　处：《中华肾脏病杂志》2023年第9期688-696,共9页Chinese Journal of Nephrology

摘　　要：目的探讨长透析间期前增加超滤率与维持性血液透析(maintenance hemodialysis, MHD)患者住院风险的相关性。方法该研究为回顾性研究, 纳入2020年8—11月广州医科大学附属第三医院血液透析中心的MHD患者, 收集和分析其人口学特征、疾病相关、实验室检查等资料。将患者实际超滤率>计划超滤率定义为增加超滤率, 并将其分为增加超滤率组和对照组, 比较两组患者临床资料的差异。实际超滤率>13 ml·kg^(-1)·h-1定义为高超滤率。采用多因素Logistic回归模型分析高超滤率和增加超滤率与MHD患者发生住院(全因、心血管、心力衰竭住院事件)的相关性。采用受试者工作特征曲线探讨实际超滤率及额外超滤率百分比对透析低血压具有预测价值的最佳切点。结果该研究共纳入126例MHD患者, 年龄(57.48±13.81)岁, 其中男性67例(53.2%), 女性59例(46.8%), 增加超滤率组69例(54.8%), 对照组57例(45.2%)。随访时间2年, 全因住院69例(54.8%), 心血管住院37例(29.4%), 心力衰竭住院25例(19.8%), 透析低血压43例(34.1%)。增加超滤率组体重指数(t=4.343, P<0.001)和实际超滤率(t=4.694, P<0.001)均高于对照组。多因素Logistic回归分析结果显示, 校正年龄、性别和心血管疾病后, 高超滤率与MHD患者发生心血管住院风险增加独立相关(OR=2.871, 95%CI 1.202~6.854, P=0.018);校正年龄和血白蛋白后, 增加超滤率与MHD患者发生心力衰竭住院风险下降相关(OR=0.302, 95%CI 0.112~0.812, P=0.018);当实际超滤率≤13 ml·kg^(-1)·h-1 时, 增加超滤率与MHD患者发生心力衰竭住院(校正血白蛋白, OR=0.044, 95%CI 0.005~0.360, P=0.004)和心血管住院(校正年龄, OR=0.052, 95%CI 0.010~0.259, P<0.001)风险下降相关。受试者工作特征曲线分析结果显示, 实际超滤率预测MHD患者透析低血压风险的AUC为0.734(95%CI 0.633~0.835, P<0.001), 最佳切点为13.8 ml·kg^(-1)·h-1, 敏感度和特异度分别为0.488�Objective To explore the association between increasing ultrafiltration rate before a long interdialytic interval and hospitalization risk in maintenance hemodialysis(MHD)patients.Methods A retrospective study was conducted to collect and analyze the demographic characteristics,disease-related,and laboratory indicators of MHD patients in the hemodialysis center of the Third Affiliated Hospital of Guangzhou Medical University from August to November 2020.The actual ultrafiltration rate higher than the planned ultrafiltration rate was defined as increased ultrafiltration rate.The patients were divided into increased ultrafiltration rate group and control group,and the differences of clinical data between the two groups were compared.The actual ultrafiltration rate>13 ml·kg^(-1)·h-1 was defined as high filtration rate.Multivariate logistic regression analysis was used to assess the association between high ultrafiltration rate,increased ultrafiltration rate in MHD patients and occurrence of hospitalization(all cause,cardiovascular,and heart failure events).The receiver-operating characteristic curve was performed to evaluate the best cut point value of actual ultrafiltration rate and percentage of additional ultrafiltration rate for predicting intradialytic hypotension.Results A total of 126 MHD patients were included in the study,with age of(57.48±13.81)years old,including 67 males(53.2%)and 59 females(46.8%).There were 69 patients(54.8%)in the increased ultrafiltration rate group,and 57 patients(45.2%)in the control group.During 2-year follow-up period,there were 69 patients(54.8%)of all cause hospitalization,37 patients(29.4%)of cardiovascular hospitalization,25 patients(19.8%)of heart failure hospitalization,and 43 patients(34.1%)of intradialytic hypotension.The body mass index(t=4.343,P<0.001)and actual ultrafiltration rate(t=4.694,P<0.001)in the increased ultrafiltration rate group were higher than those in the control group.Multivariate logistic regression analysis results showed that high ultrafiltration

关 键 词：肾透析 超滤 住院 透析超滤率 

分 类 号：R692.5[医药卫生—泌尿科学]