<br>透析期间和透析期间血压指标并不是透析期间高血压患者 44 小时动态血压的有效估计值,International Urology and Nephrology

当前位置： X-MOL 学术 › Int. Urol. Nephrol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

透析期间和透析期间血压指标并不是透析期间高血压患者 44 小时动态血压的有效估计值
International Urology and Nephrology ( IF 1.8 ) Pub Date : 2022-09-24 , DOI: 10.1007/s11255-022-03369-0
Marieta P Theodorakopoulou ₁ , Maria-Eleni Alexandrou ₁ , Fotini Iatridi ₁ , Antonios Karpetas ₂ , Virginia Geladari ₁ , Eva Pella ₁ , Sophia Alexiou ₁ , Maria Sidiropoulou ₃ , Stavroula Ziaka ₄ , Aikaterini Papagianni ₁ , Pantelis Sarafidis ₁

Affiliation

目的

与透析期间血压 (BP) 相比，透析期间和家庭血压测量是血液透析患者动态血压负荷的准确指标。本研究评估了不同血液透析人群（透析中高血压 (IDH) 患者）透析期间、透析中和预定透析间期记录与 44 小时血压的一致性。

方法

这项研究包括 45 名具有有效 48 小时 ABPM 的 IDH 患者和 197 名无 IDH 的患者。使用 44 小时血压作为参考方法，我们测试了以下血压指标的准确性：透析前和透析后、平均透析中血压和中位血压、平均透析中血压加上透析前/透析后血压以及计划透析间血压（超出透析时间）透析日：上午 8:00/下午 8:00 读数的平均值）。

结果

在 IDH 患者中，透析期间和透析期间血压指标至多显示中等相关性，而平均透析间 SBP/DBP 与 44 小时 SBP/DBP 表现出强相关性 ( r = 0.882/ r = 0.855)。 Bland-Altman 图显示透析期间和透析中血压的方法间差异较大，但方法间差异仅为 + 0.7 mmHg，平均透析间 SBP 的一致性限度为 95%。诊断 44 小时 SBP ≥ 130 mmHg 的敏感性/特异性和 κ 统计量在透析前（72.5/40.0%，κ 统计量 = 0.074）和透析后（90.0/0.0%，κ 统计量 = −）较低0.110）、平均透析中收缩压（85.0/40.0%，κ-统计量 = 0.198）、中位透析中收缩压（85.0/60.0%，κ-统计量 = 0.333）以及透析中加透析前/透析后 SBP（85.0/20.0%，κ-统计量 = 0.043）。平均透析间 SBP 显示出高敏感性/特异性 (97.5/80.0%) 和很强的一致性 (κ 统计量 = 0.775)。在 ROC 分析中，预定透析间期 SBP/DBP 具有最高的 AUC (0.967/0.951)、敏感性 (90.0/88.0%) 和特异性 (100.0/90.0%)。

结论

在 IDH 患者中，仅平均预定透析间期记录而非透析前和透析后记录，透析中血压记录也未显示与 ABPM 的合理一致性。透析间血压记录只能用于这些受试者的高血压诊断和管理。

"点击查看英文标题和摘要"

Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension

Purpose

In contrast to peridialytic blood pressure (BP), intradialytic and home BP measurements are accurate metrics of ambulatory BP load in hemodialysis patients. This study assessed the agreement of peridialytic, intradialytic, and scheduled interdialytic recordings with 44-h BP in a distinct hemodialysis population, patients with intradialytic hypertension (IDH).

Methods

This study included 45 IDH patients with valid 48-h ABPM and 197 without IDH. With 44-h BP used as reference method, we tested the accuracy of the following BP metrics: Pre- and post-dialysis, mean and median intradialytic, mean intradialytic plus pre/post-dialysis, and scheduled interdialytic BP (out-of-dialysis day: mean of 8:00am/8:00 pm readings).

Results

In IDH patients, peridialytic and intradialytic BP metrics showed at best moderate correlations, while averaged interdialytic SBP/DBP exhibited strong correlation (r = 0.882/r = 0.855) with 44-h SBP/DBP. Bland–Altman plots showed large between-method-difference for peri- and intradialytic-BP, but only + 0.7 mmHg between-method difference and good 95% limits of agreement for averaged interdialytic SBP. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP ≥ 130 mmHg were low for pre-dialysis (72.5/40.0%, κ-statistic = 0.074) and post-dialysis (90.0/0.0%, κ-statistic = − 0.110), mean intradialytic (85.0/40.0%, κ-statistic = 0.198), median intradialytic (85.0/60.0%, κ-statistic = 0.333), and intradialytic plus pre/post-dialysis SBP (85.0/20.0%, κ-statistic = 0.043). Averaged interdialytic SBP showed high sensitivity/specificity (97.5/80.0%) and strong agreement (κ-statistic = 0.775). In ROC analyses, scheduled interdialytic SBP/DBP had the highest AUC (0.967/0.951), sensitivity (90.0/88.0%), and specificity (100.0/90.0%).

Conclusion

In IDH patients, only averaged scheduled interdialytic but not pre- and post-dialysis, nor intradialytic BP recordings show reasonable agreement with ABPM. Interdialytic BP recordings only could be used for hypertension diagnosis and management in these subjects.

更新日期：2022-09-25

点击分享查看原文

点击收藏

公开下载

阅读更多本刊新发论文本刊介绍/投稿指南