PDF(Pubmed)
Abstract：
UNASSIGNED: Fluid and salt overload in patients on dialysis result in high blood pressure (BP), left ventricular hypertrophy (LVH) and hemodynamic instability, resulting in cardiovascular morbidity.
UNASSIGNED: Analysis of 910 pediatric patients on maintenance hemodialysis/hemodiafiltration (HD/HDF), prospectively followed-up with 2758 observations recorded every 6-months in the International Pediatric Hemodialysis Network (IPHN).
UNASSIGNED: Uncontrolled hypertension was present in 55% of observations, with 27% of patients exhibiting persistently elevated predialysis BP. Systolic and diastolic age- and height-standardized BP (BP-SDS) were independently associated with the number of antihypertensive medications (odds ratio [OR] = 1.47, 95% confidence interval 1.39-1.56, 1.36 [1.23-1.36]) and interdialytic weight gain (IDWG; 1.19 [1.14-1.22], 1.09 [1.06-1.11]; all P < 0.0001). IDWG was related to urine output (OR = 0.27 [0.23-0.32]) and dialysate sodium (dNa; 1.06 [1.01-1.10]; all P < 0.0001). The prevalence of masked hypertension was 24%, and HD versus HDF use was an independent risk factor of elevated age- and height-standardized mean arterial pressure (MAP-SDS) (OR = 2.28 [1.18-4.41], P = 0.01). Of the 1135 echocardiograms, 51% demonstrated LVH. Modifiable risk factors included predialysis systolic BP-SDS (OR = 1.06 [1.04-1.09], P < 0.0001), blood hemoglobin (0.97 [0.95-0.99], P = 0.004), HD versus HDF modality (1.09 [1.02-1.18], P = 0.01), and IDWG (1.02 [1.02-1.03], P = 0.04). In addition, HD modality increased the risk of LVH progression (OR = 1.23 [1.03-1.48], P = 0.02). Intradialytic hypotension (IDH) was prevalent in patients progressing to LVH and independently associated with predialysis BP-SDS below 25th percentile, lower number of antihypertensives, HD versus HDF modality, ultrafiltration (UF) rate, and urine output, but not with dNa.
UNASSIGNED: Uncontrolled hypertension and LVH are common in pediatric HD, despite intense pharmacologic therapy. The outcome may improve with use of HDF, and superior anemia and IDWG control; the latter via lowering dNa, without increasing the risk of IDH.
UNASSIGNED: Analysis of 910 pediatric patients on maintenance hemodialysis/hemodiafiltration (HD/HDF), prospectively followed-up with 2758 observations recorded every 6-months in the International Pediatric Hemodialysis Network (IPHN).
UNASSIGNED: Uncontrolled hypertension was present in 55% of observations, with 27% of patients exhibiting persistently elevated predialysis BP. Systolic and diastolic age- and height-standardized BP (BP-SDS) were independently associated with the number of antihypertensive medications (odds ratio [OR] = 1.47, 95% confidence interval 1.39-1.56, 1.36 [1.23-1.36]) and interdialytic weight gain (IDWG; 1.19 [1.14-1.22], 1.09 [1.06-1.11]; all P < 0.0001). IDWG was related to urine output (OR = 0.27 [0.23-0.32]) and dialysate sodium (dNa; 1.06 [1.01-1.10]; all P < 0.0001). The prevalence of masked hypertension was 24%, and HD versus HDF use was an independent risk factor of elevated age- and height-standardized mean arterial pressure (MAP-SDS) (OR = 2.28 [1.18-4.41], P = 0.01). Of the 1135 echocardiograms, 51% demonstrated LVH. Modifiable risk factors included predialysis systolic BP-SDS (OR = 1.06 [1.04-1.09], P < 0.0001), blood hemoglobin (0.97 [0.95-0.99], P = 0.004), HD versus HDF modality (1.09 [1.02-1.18], P = 0.01), and IDWG (1.02 [1.02-1.03], P = 0.04). In addition, HD modality increased the risk of LVH progression (OR = 1.23 [1.03-1.48], P = 0.02). Intradialytic hypotension (IDH) was prevalent in patients progressing to LVH and independently associated with predialysis BP-SDS below 25th percentile, lower number of antihypertensives, HD versus HDF modality, ultrafiltration (UF) rate, and urine output, but not with dNa.
UNASSIGNED: Uncontrolled hypertension and LVH are common in pediatric HD, despite intense pharmacologic therapy. The outcome may improve with use of HDF, and superior anemia and IDWG control; the latter via lowering dNa, without increasing the risk of IDH.
摘要：
■透析患者的液体和盐超负荷导致高血压（BP），左心室肥厚（LVH）和血流动力学不稳定，导致心血管疾病。
■910例维持性血液透析/血液透析滤过（HD/HDF）儿科患者的分析，前瞻性随访,每6个月在国际儿科血液透析网络(IPHN)记录2758次观察.
■在55％的观察中存在未控制的高血压，27%的患者透析前血压持续升高。收缩压和舒张年龄和身高标准化BP（BP-SDS）与抗高血压药物的数量（比值比[OR]=1.47，95％置信区间1.39-1.56，1.36[1.23-1.36]）和透析间体重增加（IDWG;1.19[1.14-1.22]，1.09[1.06-1.11];所有P<0.0001)。IDWG与尿量(OR=0.27[0.23-0.32])和透析液钠(dNa;1.06[1.01-1.10];均P<0.0001)相关。隐性高血压的患病率为24%,HD和HDF的使用是年龄和身高标准化平均动脉压（MAP-SDS）升高的独立危险因素（OR=2.28[1.18-4.41]，P=0.01）。在1135张超声心动图中,51%表示为LVH。可改变的危险因素包括透析前收缩压BP-SDS（OR=1.06[1.04-1.09]，P<0.0001),血血红蛋白（0.97[0.95-0.99]，P=0.004),HD与HDF模式（1.09[1.02-1.18]，P=0.01),和IDWG(1.02[1.02-1.03],P=0.04)。此外,HD模式增加LVH进展的风险（OR=1.23[1.03-1.48]，P=0.02)。透析中低血压（IDH）在进展为LVH的患者中普遍存在，并且与透析前BP-SDS低于25百分位数独立相关，抗高血压药的数量减少，HD与HDF模式，超滤（UF）率，和尿量,但不是dna.
■未控制的高血压和LVH在小儿HD中很常见，尽管进行了激烈的药物治疗。使用HDF可能会改善结果，和优越的贫血和IDWG控制；后者通过降低dNa，不会增加IDH的风险。
■910例维持性血液透析/血液透析滤过（HD/HDF）儿科患者的分析，前瞻性随访,每6个月在国际儿科血液透析网络(IPHN)记录2758次观察.
■在55％的观察中存在未控制的高血压，27%的患者透析前血压持续升高。收缩压和舒张年龄和身高标准化BP（BP-SDS）与抗高血压药物的数量（比值比[OR]=1.47，95％置信区间1.39-1.56，1.36[1.23-1.36]）和透析间体重增加（IDWG;1.19[1.14-1.22]，1.09[1.06-1.11];所有P<0.0001)。IDWG与尿量(OR=0.27[0.23-0.32])和透析液钠(dNa;1.06[1.01-1.10];均P<0.0001)相关。隐性高血压的患病率为24%,HD和HDF的使用是年龄和身高标准化平均动脉压（MAP-SDS）升高的独立危险因素（OR=2.28[1.18-4.41]，P=0.01）。在1135张超声心动图中,51%表示为LVH。可改变的危险因素包括透析前收缩压BP-SDS（OR=1.06[1.04-1.09]，P<0.0001),血血红蛋白（0.97[0.95-0.99]，P=0.004),HD与HDF模式（1.09[1.02-1.18]，P=0.01),和IDWG(1.02[1.02-1.03],P=0.04)。此外,HD模式增加LVH进展的风险（OR=1.23[1.03-1.48]，P=0.02)。透析中低血压（IDH）在进展为LVH的患者中普遍存在，并且与透析前BP-SDS低于25百分位数独立相关，抗高血压药的数量减少，HD与HDF模式，超滤（UF）率，和尿量,但不是dna.
■未控制的高血压和LVH在小儿HD中很常见，尽管进行了激烈的药物治疗。使用HDF可能会改善结果，和优越的贫血和IDWG控制；后者通过降低dNa，不会增加IDH的风险。
