| BackgroundMaintenance hemodialysis is one of the most important treatments for end-stage renal disease patients to live by. Along with the technology of blood purification increasingly perfect and mature, the survival time of chronic hemodialysis patients becomes longer. However, the incidence of complications and mortality remain high. It is still the top concern all over the world that the investigation of long-term outcome and its correlative factors in patients with maintenance hemodialysis.Hypertension is a common complication in hemodialysis patients. Twenty-four hours ambulatory blood pressure monitoring can reflect the level and circadian rhythm of human blood pressure more veritably. So it has great clinical value predicting target organ damage and adverse events and estimating prognosis of diseases.ObjectiveTo investigate factors that influence clinical outcome and long-term survival by analyzing the clinical data of patients with maintenance hemodialysis. Particularly to explore the prognostic value of ABPM for patients with MHD.Methods41 MHD patients recruited into our study were diagnosed with end-stage renal disease in our hospital between November 2006 and Apirl 2007. We retrospectively studied clinical records of these patients who were grouped into two according to different clinical outcomes followed until August 2010:survival group and death group. The data on the demographic, epidemiologic, serum biochemical aspects as well as ABPM results of these patients were examined. The long-term survival rates and impact factors were analyzed. Univariate and multivariate analysis Cox regression proportional hazard model were used to analysis the risk factors influencing the prognosis.Results①Among the 41 MHD patients,20 were male and 21 were female, and the ratio of male to female was 0.95 to 1, The mean initial age of HD was (61.20±11.64) years old, duration of HD was (32.98±24.53)months. In survival group,11 were male and 14 were female; while in death group,9 were male and 7 were female. The mean age, the initial age of HD and duration of HD of the two groups respectively were (58.90±12.09) years old vs (69.25±9.22) years old, (57.12±11.79) years olds vs (67.56±8.26) years olds, (27.72±22.21) months vs (41.19±26.41) months. There were significant differences in the mean age, the initial age of HD between the two groups.②Secondary glomerular disease was the most frequent cause of ESRD, and accounted for 48.78% in our patients, primary glomerular disease for 29.27%. In the younger patient (<50y at the start of HD) group, primary glomerulonephritis accounted for 66.67%;while in the older group (≥50y at the start of HD), the majority were secondary glomerular disease accounted for 59.38%.③The following ABPM parameters,such as 24hPP, dPP, nPP, ARV24hSBP were higher in death group than in survival group(P<0.05), but the nocturnal blood pressure fall of SBP and DBP were lower (P<0.05).④The 1 year,5 year,7 year survival rate of patients with MHD was 98%,79%, 50% respectively. Older age, older age at the start of HD, secondary glomerular disease were adverse factors for survival.⑤Cox regression proportional hazard analyses showed that higher average real variability of 24h systolic pressure predicted total mortality (HR:1.160) in MHD patients, while Kt/V and nocturnal systolic blood pressure fall were protective factors associated with prognosis (HR:0.042,0.907 respectively)Conclusion①In our study, the majority of the ESRD patients was eldly females, with secondary glomerular disease as the most common cause, while the causes were distinct for different groups of initial ages of HD.②There were significant differences in the mean age, the mean initial age of HD, 24hPP, dPP, nPP, ARV24hSBP, the nocturnal blood pressure fall of SBP and DBP between the survival and death group.③The 1 year,5 year,7 year survival rate of patients with MHD was 98%,79%, 50% respectively. Insufficiency of HD, bigger average real variability of 24h systolic pressure, lack of decline of nocturnal systolic blood pressure were the risk factors for MHD patients to survive. BackgroundWith the development of ambulatory blood pressure monitoring and associated clinical research, it has been accepted that blood pressure rhythm and nocturnal hypertension play an important role in predicting target organ damage and cadiovascular events and estimating prognosis and risk of death. Factors that impact the changes of nocturnal blood pressure are too sophisticated to be understood clearly.ObjectiveTo investigate factors that influence the variations interdialytic nighttime blood pressure by analyzing the clinical data of patients with maintenance hemodialysis.Methods25 MHD patients with nocturnal hypertension of the survival group recruited into our study above underwent an ambulatory blood pressure monitoring between two dialysis sessions. The data of ABPM as well as echocardiography and serum biochemical indicators were examined. They were grouped into two according to different variation trend whether nocturnal hypertension or not:improvement and nonimprovement of nocturnal blood pressure groups. Clinical records on epidemiologic, hematological, ABPM and cardiac ultrasonic aspects of the two groups were compared by independent-samples T test or Fisher exact method. Logistic regression model was used to analysis the risk factors influencing of the changes of interdialytic nocturnal blood pressure in MHD patients.Results①The mean age, parathyroid hormone, ambulatory arterial stiffness index, left ventricular mass index in the nonimprovement of nocturnal blood pressure group were obviously higher than those in the improvement group and these differences had statistically significant (P<0.05).②Univariate Logistic regression proportional analyses showed that age, parathyroid hormone, ambulatory arterial stiffness index, symmetrical ambulatory arterial stiffness index, left ventricular hypertrophy are the influencing factors of interdialytic nocturnal hypertension in MHD patients, while multivariate Logistic regression analyses showed that the independent risk factors of nocturnal hypertension were older age,bigger sym-AASI and LVH.ConclusionOlder age, arterial sclerosis and left ventricular hypertrophy were the independent risk factors influencing nocturnal blood pressure in maintenance hemodialysis patients. PTH may be involved in the regulation of nocturnal blood pressure via mediating arterial sclerosis and left ventricular hypertrophy.
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