血液透析开始时较高的NT-proBNP水平和透析内低血压的风险。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2023-10-24 DOI:10.1111/hdi.13125

Katherine A. Curtis, Sushrut S. Waikar, Finnian R. Mc Causland

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引用次数: 0

摘要

引言：升高的N-末端B型利钠肽原（NT-proBNP）是血液透析开始时不良结果的有力预测因子。这些患者经常出现透析内低血压，这可能部分反映了心脏功能障碍，但NT-proBNP与透析内低血压的关系尚不清楚。方法：我们对一项随机试验进行了事后分析，该试验在52名开始血液透析的患者中测试了甘露醇与安慰剂（NCT01520207）。在第一次和第三次治疗前测量NT-proBNP（n = 87）。混合效应模型（调整随机治疗、性别、种族、年龄、糖尿病、心力衰竭、导管使用、透析前收缩压、透析前体重、超滤量、血清钠、碳酸氢盐、尿素氮、磷酸盐、白蛋白、血红蛋白和疗程时长）适用于检查NT-proBNP与收缩压下降的关系（透析前减去最低点收缩压）。此外，混合效应泊松模型适用于检查与透析内低血压（≥20 收缩压下降mmHg）。结果：平均年龄为55岁 ± 16 年；33%的患者有基线心力衰竭。NT-proBNP中位数为5498[25-75百分位201114790]pg/mL；26个疗程（30%）并发透析内低血压。在调整后的模型中，每单位高log NT-proBNP与6.0相关收缩压下降幅度小于mmHg（95%CI-9.2至-2.8）。透析前NT-proBNP升高，每对数单位，与透析内低血压风险降低52%相关（IRR 0.48，95%CI 0.23-0.97），没有证据表明随机治疗（P-相互作用 = 0.17）。讨论：在开始血液透析的患者中，较高的NT-proBNP与透析内收缩压下降较少和透析内低血压风险较低有关。未来的研究应该调查透析前较高的NT-proBNP水平是否可以识别出可能耐受更积极超滤的患者。

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Higher NT-proBNP levels and the risk of intradialytic hypotension at hemodialysis initiation

Introduction

Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) is a potent predictor of adverse outcomes in hemodialysis initiation. These patients often experience intradialytic hypotension, which may partially reflect cardiac dysfunction, but the association of NT-proBNP with intradialytic hypotension is not clear.

Methods

We performed a post hoc analysis of a randomized trial that tested mannitol versus placebo in 52 patients initiating hemodialysis (NCT01520207). NT-proBNP was measured prior to the first and third sessions (n = 87). Mixed-effects models (adjusting for randomized treatment, sex, race, age, diabetes, heart failure, catheter use, pre-dialysis systolic blood pressure, pre-dialysis weight, ultrafiltration volume, serum sodium, bicarbonate, urea nitrogen, phosphate, albumin, hemoglobin, and session length) were fit to examine the association of NT-proBNP with systolic blood pressure decline (pre-dialysis minus nadir systolic blood pressure). Additionally, mixed-effects Poisson models were fit to examine the association with intradialytic hypotension (≥20 mmHg decline in systolic blood pressure).

Findings

Mean age was 55 ± 16 years; 33% had baseline heart failure. The median NT-proBNP was 5498 [25th-75th percentile 2011, 14,790] pg/mL; 26 sessions (30%) were complicated by intradialytic hypotension. In adjusted models, each unit higher log-NT-proBNP was associated with 6.0 mmHg less decline in systolic blood pressure (95%CI −9.2 to −2.8). Higher pre-dialysis NT-proBNP, per log-unit, was associated with a 52% lower risk of intradialytic hypotension (IRR 0.48, 95%CI 0.23–0.97), without evidence for effect modification by randomized treatment (P-interaction = 0.17).

Discussion

In patients initiating hemodialysis, higher NT-proBNP is associated with less decline in intradialytic systolic blood pressure and lower risk of intradialytic hypotension. Future studies should investigate if higher pre-dialysis NT-proBNP levels may identify patients who might tolerate more aggressive ultrafiltration.

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.