| Objective:Patients with end-stage renal disease(ESRD)receiving maintenance hemodialysis(MHD)were studied to investigate the changes in blood pressure during hemodialysis treatment and to explore and analyze the influencing factors.Methods:From June 1,2018 to November 30,2018,patients who were diagnosed with ESRD and received MHD in the blood purification center of our Affiliated hospital of zunyi medical university were selected as the study subjects.According to the inclusion and exclusion criteria,a total of 229 cases,7433 dialysis sessions and 37165 times of blood pressure records were included for investigation and analysis.General clinical data,laboratory examination results,dialysis regimen and treatment,and possible factors affecting blood pressure were collected.Based on the influence of basic factors and dialysis-related factors on blood pressure changes during dialysis treatment,Therefore,7433 dialysis sessions were divided into groups according to the changes of blood pressure during each dialysis treatment: group A(hypotensive group),group B(stable blood pressure group),and group C(elevated blood pressure group).The differences of dialysis-related factors among the three groups were analyzed,and the influencing factors of hypertension and hypotension in dialysis were analyzed by binary multivariate logistic regression.The blood pressure changes of 37165 times during 7433 dialysis treatments were analyzed.229 patients were divided into groups according to 5 blood pressure changes during the first dialysis treatment upon enrollment in June 2018: group I(hypotensive group),group II(stable blood pressure group),and group III(elevated blood pressure group),The differences of basic factors among the threegroups were analyzed,and the influencing factors of hypertension and hypotension in dialysis were analyzed by binary multivariate logistic regression.Results:1.229 MHD patients and 7433 dialysis sessions were included in this study.There were 139 male patients(60.7%)and 90 female patients(39.3%),with an average age of49.73±13.79 years(22-89 years),and an average dialysis age of 49.73±40.1 months(3-194months).Dialysis 2 and 3 times per week accounted for 48% and 52%,respectively.The duration of dialysis was 4h/ time,accounting for 87.3%.Among the basic diseases,154cases(67.2%)were chronic glomerulonephritis,42 cases(18.4%)were hypertension,and16 cases(7.0%)were diabetes.2.Among the 229 MHD patients receiving 7433 dialysis treatments,group A accounted for 42.7%,group B for 36.9%,and group C for 20.4%.The incidence of hypotension,stable blood pressure and hypertension was 24.3%,66.7% and 9.0%,respectively,in the 29732 Blood Pressure records after the start of dialysis treatment.3.Among the 229 MHD patients receiving 7433 times of dialysis,the rate of blood pressure control before dialysis was 50.6%,and that after dialysis was 25.6%.The rate of blood pressure control before dialysis was A< B < C group(P < 0.05).The blood pressure compliance rate after dialysis was A >B > C group(P < 0.05).4.In group A,the incidence of hypotension at 1h,2h,3h and the end of dialysis was50.4%,55.8%,65.9% and 54.7%,respectively.The incidence of hypotension at 3h after dialysis was at other time points(P < 0.05).In group C,the incidence of hypertension at 1h,2h,3h,and the end of dialysis was 16%,32.5%,45.5%,and 71.7%,respectively,especially at the end of dialysis(P < 0.05).5.Among the 229 MHD patients,93 cases in group I,103 cases in group II and 33 cases in group III were included.Binary multivariate logistic regression analysis showed that: large number of antihypertensive drugs,low creatinine and low albumin were risk factors for hypertension in dialysis.6.Among the 7433 dialysis treatments,3173 were performed in group A,2741 in group B,and 1519 in group C.Binary multivariate logistic regression analysis showed that low blood flow,high SBP,high DBP and hemodialysis filtration were risk factors for intradialytic hypotension.Low ultrafiltration,high interdialysis weight growth rate,high predialysis SBP and low predialysis DBP are risk factors for intradialytic hypertensions.Conclusion:1.The incidence of hypotension in our blood purification center is higher than that of hypertension in dialysis.2.The blood pressure compliance rate of maintenance hemodialysis patients before dialysis is higher than that after dialysis in our blood purification center.3.There are many factors influencing blood pressure changes during dialysis.Low blood flow,high predialysis SBP,high predialysis DBP and hemodialysis filtration are risk factors for intradialytic hypotension.High number of antihypertensive drugs,low level of creatinine,low level of albumin,low ultrafiltration,high interdialysis weight growth rate,high predialysis SBP and low predialysis DBP are risk factors for intradialytic hypertensions. |
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