La hipertensión arterial intradiálisis, un diagnóstico por descubrir

IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Nefrologia Pub Date : 2024-09-01 DOI:10.1016/j.nefro.2023.12.003
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引用次数: 0

Abstract

Introduction

Intradialytic hypertension (IDH) is a poorly understood phenomenon with no consensus on its definition, etiology, or related factors, and there is limited evidence on its consequences.

Objective

To determine the prevalence of IDH according to different definitions in hemodialysis (HD) units, with different clinical practices and assessment of possible events after 18 months have passed.

Materials and methods

A cross-sectional observational study was conducted in two HD units, including all prevalent patients from March 2021 to September 2022. We established three definitions of IDH: Def 1: Mean arterial pressure (MAP) difference pre- and pos-HD > 15 mmHg. Def 2: Systolic blood pressure (SBP) difference pre- and pos-HD > 10 mmHg. Def 3: SBP difference >0 and ultrafiltration rate (UFR) > 5 ml/kg/h.

IDH was considered present if the criterion was met in more than 50% of the six consecutive sessions (2 weeks) of follow-up. Personal history, medications, dialysis characteristics, and pre- and post-HD biochemical data were collected. Residual renal function (RRF) was considered as urine output >250 ml/24 h. At 18 months, the possible events of the group were analyzed.

Results

We included 169 patients (68% men) with a mean age of 67.9 (14.2) years and a median HD duration of 34.5 (IQR: 17.5-67.5) months. Of these, 94 come from one unit and 75 from the other. The prevalence of IDH was 8.3% according to Def 1, 27.2% according to Def 2, and 29.6% according to Def 3. Def 2 showed an association with a history of previous hypertension, use of renin-angiotensin system inhibitors (RASIs), and furosemide, as well as with patients with RRF. Def 3 showed an association only with coronary artery disease. There was an association with different prescriptions of dialysis fluids. Catecholaminergic hormones and aldosterone did not increase in patients with hypertension during the HD session. They did not present a higher incidence of cardiovascular events or mortality at 18 months.

Conclusions

IDH has different prevalence rates depending on the definition used and the studied center. The future poses an important challenge: to determine which definition correlates with higher morbidity and mortality and the role of differences found in different HD units.

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椎管内动脉高血压,一种尚未发现的诊断方法
导言血液透析高血压(IDH)是一种鲜为人知的现象,其定义、病因或相关因素尚未达成共识,有关其后果的证据也很有限。目的根据血液透析(HD)单位的不同定义确定 IDH 的患病率,并在 18 个月后对可能发生的事件进行评估。我们确定了三种 IDH 定义:定义 1:HD 前和 HD 后的平均动脉压(MAP)差值为 15 mmHg。定义 2:收缩压(SBP)差值为 10 mmHg。定义 3:SBP 差值为 0,超滤率(UFR)为 5 毫升/千克/小时。如果在连续六次(2 周)随访中,有 50% 以上的时间符合标准,则认为存在 IDH。研究人员收集了个人病史、用药情况、透析特点以及血液透析前后的生化数据。18 个月后,对该组患者可能发生的事件进行了分析。结果 我们纳入了 169 名患者(68% 为男性),平均年龄为 67.9(14.2)岁,中位透析时间为 34.5(IQR:17.5-67.5)个月。其中 94 人来自一个单位,75 人来自另一个单位。根据 Def 1,IDH 患病率为 8.3%;根据 Def 2,患病率为 27.2%;根据 Def 3,患病率为 29.6%。Def 2 与既往高血压病史、使用肾素-血管紧张素系统抑制剂(RASIs)和呋塞米以及 RRF 患者有关。Def 3 仅显示与冠状动脉疾病有关。与不同的透析液处方有关。在血液透析过程中,高血压患者体内的儿茶酚胺激素和醛固酮没有增加。结论 高血压的发病率因所使用的定义和研究中心而异。未来面临的一个重要挑战是:确定哪种定义与较高的发病率和死亡率相关,以及不同 HD 单位的差异所起的作用。
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来源期刊
Nefrologia
Nefrologia 医学-泌尿学与肾脏学
CiteScore
3.40
自引率
7.70%
发文量
148
审稿时长
47 days
期刊介绍: Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.
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