PDF(Pubmed)
Abstract：
BACKGROUND: Diabetes mellitus is a common cause of kidney failure and is often complicated by autonomic neuropathy, which may have implications for blood pressure (BP) homeostasis during hemodialysis (HD).
METHODS: In this post hoc analysis of the Frequent Hemodialysis Network (FHN) Daily Trial, we used random effects Poisson and linear regression models to estimate the association of diabetes (vs. not) with intra-dialytic hypotension (IDH) and peri-dialytic BP parameters, respectively. We tested for differential associations according to the randomized treatment (6/week vs. 3/week HD) and pre-HD systolic BP.
RESULTS: Of the 244 patients with intra-dialytic BP data, 100 (41%) had diabetes at baseline. The mean age was 51 ± 14 years; overall, 39% were female. In adjusted models, diabetes (vs. not) was associated with a 93% higher risk of developing IDH (IRR: 1.93; 95% CI: 1.26, 2.95). There was no evidence that the randomized treatment assignment modified the association between diabetes and IDH (pinteraction = 0.32), but more potent associations were noted among those with higher pre-HD systolic BP (pinteraction < 0.001). Diabetes (vs. not) was associated with a lower adjusted nadir intra-HD BP (-4.2; 95% CI: -8.3, -0.2 mm Hg) but not with the pre- or post-HD systolic BP.
CONCLUSIONS: Among participants of the FHN Daily Trial, patients with diabetes had a higher risk of IDH and lower nadir intra-HD systolic BP than patients without diabetes, even when undergoing HD up to 6 times per week.
METHODS: In this post hoc analysis of the Frequent Hemodialysis Network (FHN) Daily Trial, we used random effects Poisson and linear regression models to estimate the association of diabetes (vs. not) with intra-dialytic hypotension (IDH) and peri-dialytic BP parameters, respectively. We tested for differential associations according to the randomized treatment (6/week vs. 3/week HD) and pre-HD systolic BP.
RESULTS: Of the 244 patients with intra-dialytic BP data, 100 (41%) had diabetes at baseline. The mean age was 51 ± 14 years; overall, 39% were female. In adjusted models, diabetes (vs. not) was associated with a 93% higher risk of developing IDH (IRR: 1.93; 95% CI: 1.26, 2.95). There was no evidence that the randomized treatment assignment modified the association between diabetes and IDH (pinteraction = 0.32), but more potent associations were noted among those with higher pre-HD systolic BP (pinteraction < 0.001). Diabetes (vs. not) was associated with a lower adjusted nadir intra-HD BP (-4.2; 95% CI: -8.3, -0.2 mm Hg) but not with the pre- or post-HD systolic BP.
CONCLUSIONS: Among participants of the FHN Daily Trial, patients with diabetes had a higher risk of IDH and lower nadir intra-HD systolic BP than patients without diabetes, even when undergoing HD up to 6 times per week.
摘要：
糖尿病是肾衰竭的常见原因，常并发自主神经病变，这可能对血液透析（HD）期间的血压（BP）稳态有影响。方法在对频繁血液透析网络(FHN)每日试验的事后分析中，我们使用随机效应Poisson和线性回归模型来估计糖尿病（与非糖尿病）与透析内低血压（IDH）和透析周围BP参数的关联，分别。我们根据随机治疗（6/周HDvs3/周HD）和HD前收缩压进行了差异关联测试。结果244例患者透析内血压数据，100（41%）在基线时患有糖尿病。平均年龄为51±14岁；39%为女性。在调整后的模型中，糖尿病（vs.不）与发展IDH的风险增加93％相关（IRR1.93；95％CI1.26，2.95）。没有证据表明随机治疗分配改变了糖尿病和IDH之间的关联（P-交互作用=0.32），但在HD前收缩压较高的人群中,发现有更强的关联(P-交互作用<0.001).糖尿病（vs.不是）与较低的校正最低点HD内BP（-4.2；95CI-8.3，-0.2mmHg）相关，但不是HD前或后收缩压。结论在FHN每日试验的参与者中，与无糖尿病患者相比,糖尿病患者发生透析内低血压的风险较高,而HD内收缩压的最低点较低,即使每周接受HD多达6次。
