Intradialytic Hypotension and Risk of Cardiovascular Disease
Autor: | Karthik Ramakrishnan, Nils-Olov Stålhammar, Steven M. Brunelli, Donna E. Jensen, Emmanuel Anum, Claudia Cabrera, David Rosenbaum, Bergur V. Stefánsson |
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Rok vydání: | 2014 |
Předmět: |
Male
medicine.medical_specialty Epidemiology medicine.medical_treatment Population Myocardial Infarction Weight Gain Critical Care and Intensive Care Medicine Renal Dialysis Cause of Death Internal medicine Atrial Fibrillation Prevalence Humans Medicine Intensive care medicine education Stroke Dialysis Aged Retrospective Studies Cause of death Heart Failure Transplantation education.field_of_study business.industry Incidence Incidence (epidemiology) Editorials Retrospective cohort study Original Articles Middle Aged medicine.disease United States Hospitalization Nephrology Kidney Failure Chronic Female Hemodialysis Hypotension business Kidney disease |
Zdroj: | Clinical Journal of the American Society of Nephrology. 9:2124-2132 |
ISSN: | 1555-9041 |
Popis: | Patients undergoing hemodialysis have an elevated risk of cardiovascular disease-related morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role.This study retrospectively examined records of 39,497 hemodialysis patients during 2007 and 2008. US Renal Data System claims and dialysis provider data were used to determine outcomes. IDH was defined by current Kidney Disease Outcomes Quality Initiative guidelines (≥20 mmHg fall in systolic BP from predialysis to nadir intradialytic levels plus ≥2 responsive measures [dialysis stopped, saline administered, etc.]). IDWG was measured absolutely (in kilograms) and relatively (in percentages).IDH occurred in 31.1% of patients during the 90-day exposure assessment period. At baseline, the higher the IDWG (relative or absolute), the greater the frequency of IDH (P0.001). For all-cause mortality, the median follow-up was 398 days (interquartile range, 231-602 days). Compared with patients without IDH, IDH was associated with all-cause mortality (7646 events; adjusted hazard ratio, 1.07 [95% confidence interval, 1.01 to 1.14]), myocardial infarction (2396 events; 1.20 [1.10 to 1.31]), hospitalization for heart failure/volume overload (8896 events; 1.13 [1.08 to 1.18]), composite hospitalization for heart failure/volume overload or cardiovascular mortality (10,805 events; 1.12 [1.08 to 1.17]), major adverse cardiac events (MACEs; myocardial infarction, stroke, cardiovascular mortality) (4994 events, 1.10 [1.03 to 1.17]), and MACEs+ (MACEs plus arrhythmia or hospitalization for heart failure/volume overload) (12,221 events; 1.14 [1.09 to 1.19]).IDH was potently associated with cardiovascular morbidity and mortality. Clinical trials to ascertain causality are needed and should consider reduction in IDWG as a potential means to reduce IDH. |
Databáze: | OpenAIRE |
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