Time of hemodialysis and risk of intradialytic hypotension and intradialytic hypertension in maintenance hemodialysis
JOURNAL OF HUMAN HYPERTENSION(2023)
摘要
Intradialytic hypotension and intradialytic hypertension are complications of hemodialysis (HD) associated with a higher risk of cardiovascular disease (CVD) and death. Blood pressure (BP) normally fluctuates in a circadian pattern, but whether the risk of intradialytic hypotension and intradialytic hypertension varies according to the time of the HD session is unknown. We analyzed two cohorts of thrice-weekly maintenance HD (N = 1838 patients/n = 64,503 sessions from the Hemodialysis [HEMO] Study, and N = 3302 patients/n = 33,590 sessions from Satellite Healthcare). Random effects logistic regression models examined the association of HD start time (at or before 9:00 a.m. [early AM], between 9:01 a.m. and 12:00 p.m. [late AM], and at or after 12:01 p.m. [PM]) with intradialytic hypotension (defined as nadir intra-HD systolic BP (SBP) < 90 mmHg if pre-HD SBP < 160 mmHg, or < 100 mmHg if pre-HD SBP >= 160 mmHg) and intradialytic hypertension (SBP increase >= 10 mmHg from pre-HD to post-HD). Compared to early AM, late AM and PM were associated with an 8% (aOR 0.92, 95% CI 0.83-1.02) and a 16% (aOR 0.84, 95% CI 0.75-0.95) lower risk of intradialytic hypotension in HEMO, respectively. Conversely, compared to early AM, a monotonic higher risk of intradialytic hypertension was observed for late AM (aOR 1.23, 95% CI 1.12-1.35) and PM (aOR 1.41, 95% CI 1.27-1.56) in HEMO. These findings were consistent in Satellite. In two large cohorts of maintenance HD, we observed a monotonic lower risk of intradialytic hypotension and a monotonic higher risk of intradialytic hypertension with later dialysis start times. Whether HD treatment allocation to certain times of the day in hypotensive-prone or hypertensive-prone patients improves outcomes deserves further investigation.
更多查看译文
关键词
Chronic kidney disease,Hypertension,Medical research,Medicine/Public Health,general,Epidemiology,Public Health,Health Administration
AI 理解论文
溯源树
样例
生成溯源树,研究论文发展脉络
Chat Paper
正在生成论文摘要