ABSTRACT
Objective To investigate the relationship between ultrafiltration rate (UFR) and cardiovascular death in maintenance hemodialysis patients.Methods This retrospective study observed adult hemodialysis patients treated in Kidney Disease Center,the First Affiliated Hospital,College of Medicine,Zhejiang University during January 2010 to December 2015 and the follow-up were finished at April 2017.Patients were averagely divided into 3 groups according to their UFR.Their clinic characteristics were collected,the survival rate and death related factors were analyzed by Kaplan-Meier (Log-rank test) method and Logistic regression.Results Totally 2184 patients (male 1370,62.7％) were enrolled,the age was 53.39±16.47.The UFR was (8.88±3.05) ml·h-1· kg-1.During the 7 years’ follow-up,168 patients died,of whom 58 cases (34.5％) died due to the cardiovascular events.Chi-square test showed that there were significant differences in death causes among the high,middle and low UFR group (x2=12.584,P ＜ 0.01),and the mortality rate of cardiovascular events in high UFR group was significantly higher than that in low (x2=10.861,P=0.010) and middle UFR group (x2=4.671,P=0.031).Kaplan-Meier survival curve showed that the difference of the survival rates in the 3 groups was statistically significant (Log-rank test x2=23.394,P ＜ 0.001).Cox regression analysis showed that high UFR (UFR≥10.95 ml· h-1· kg-1),old age (＞ 60 years old),and low left ventricular ejection fraction (LVEF,≤50％ were independent risk factors of cardiovascular death.Conclusions High UFR level,old age and low LVEF are independent risk factors of cardiovascular death in hemodialysis patients.Maintaining low UFR level is beneficial to reduce cardiovascular mortality in hemodialysis patients.
ABSTRACT
One of the goals of hemodialysis is to maintain normal hydration status in ESRD patients.Pre hemodialysis systolic blood pressure is usually used as a clinical parameter of hydration status and to set ultrafiltration rate before Hd. It is unclear how much pre-Hd SBP correlated with hydration status. The aimwas to determine correlation between pre-Hd SBP and hydration status before Hd. An observational correlation study was performed in two dialysis centers in Santiago, Chile, from January-June, 2011. Adult patients inHd for at least three months, who gave their informed consent were included. Patients with pacemaker,amputee, hospitalized and metallic prostheses were excluded. Total-body water and over hydrated were assessed with bioimpedance spectroscopy before the first and third dialysis session of the week. Pre-Hd SBP,pre-Hd body weight, pre-Hd TBW and pre-Hd OH, were analyzed using Pearson correlation and linear regressionmodel. 96 measurements were assessed, 52 % were male with median age 59.5 years. The correlationbetween pre-Hd SBP and pre-Hd overhydration was r=0.33, and total body water r=0.15, with a predictedvalue, R2=0.10 and R2 =0.14 respectively. Pre-Hd SBP had low correlation with pre-Hd hydration status and by itself, is not a reliable parameter to set ultrafiltration rate before Hd. Nevertheless Pre-Hd body weight predicted in 70 % the pre-Hd TBW.
Uno de los objetivos de la hemodiálisis es mantener la hidratación normal en pacientes ESRD. La presión arterial sistólica pre hemodiálisis, es usualmente utilizada como parámetro clínico del estado de hidratación y para fijar la velocidad de ultrafiltración antes de la hemodialisis. No está claro cuanto se correlacionan la presión arterial sistólica prehemodialysis con el estado de hidratación. El objetivo fue determinar la correlación entre la PAS prehemodiálisis y el estado de hidratación antes de Hd. Se realizó un estudio de correlación observacional en dos centros de diálisis de Santiago de Chile, de Enero a Junio de 2011. Se incluyeron pacientes adultos en HD durante al me-nos tres meses que dieran su consentimiento informado. Se excluyeron los pacientes con marcapasos, amputados, hospitalizados y pró-tesis metálicas. El agua corporal total y el exceso de hidratación se evaluaron con espectroscopia 1030 de bioimpedancia antes de la primera y tercera sesión de diálisis de la semana. Pre-Hd PAS, pre-Hd peso corporal, pre-Hd ACT y pre-Hd OH, se analizaron utilizando el modelo de correlación y regresión lineal de Pearson. Se evaluaron 96 mediciones, 52% eran hombres con edad media 59, 5 años. La correlación entre la PAS pre-Hd y la sobrehidratación pre-Hd fue r=0, 33 y agua corporal total r=0, 15, con un valor predicho, R2= 0, 10 y R2 = 0, 14 respectivamente. Existe baja correlación entre la PAS Pre-Hd con el esta-do de hidratación pre-Hd y por lo mismo, no es un parámetro confiable para establecer la tasa de ultrafiltración antes de Hd. Sin embargo, el peso corporal Pre-Hd predijo en un 70% el agua corporal total pre-Hd.