脈圧と死亡率との関連は,メンテナンス血液透析を受けている患者の場合です
Preston S Klassen1, Edmund G Lowrie, Donal N Reddan
1Duke Institute of Renal Outcomes Research and Health Policy, Box 3646, Duke University Medical Center, Durham, NC 27710. klass001@mc.duke.edu
JAMA
|March 26, 2002
まとめ
メンテナンス血液透析を受けている患者の場合,高脈圧は死亡リスクの増加と関連しています. これは,典型的な血圧の発見と対照的に,脈圧の圧力を強調しています.
科学分野:
- ネフロロジーと心臓血管医学
- 流行病学と公衆衛生について
背景:
- 血圧の上昇は,通常,一般の人々の有害な結果を示します.
- しかし,末期腎臓病 (ESRD) 患者のメンテナンスヘモダイアリスでは,高血圧は逆説的に死亡率の低下と関連しています.
- 脈圧は,心循環の脈動性の性質を反映し,一般の集団における重要な予測因子として浮上しています.
研究 の 目的:
- 維持血液透析を受けている患者の脈圧と死亡率の関連性を調査する.
- 脈圧の上昇は,ESRD患者の従来の血圧測定で観察された逆の関係にもかかわらず,1年以内に死亡するリスクが高いと相関しているという仮説を検証する.
主な方法:
- 遡及的なコホート研究では,782の米国の血液透析施設の37,069人の患者が参加しました.
- データは1997年10月から12月まで収集され,1998年12月まで追跡調査が行われました.
- 主なアウトカムは,1年後の全原因死亡率でした.
主要な成果:
- 透析後の脈圧の10mmHg上昇は,静脈血圧を調整した後に,死亡リスクの12%増加 (HR,1.12;95%CI,1.06-1.18) と関連していました.
- 対照的に,透析後のシストリック血圧が10mmHg上昇すると,死亡リスクが13%低下する (HR,0.87;95%CI,0.84-0.90) と関連していた.
- 脈圧の上昇に関連する要因には,高齢,糖尿病,白人,女性,透析の長期間などが含まれる.
結論:
- 脈圧は,メンテナンス血液透析患者の大規模で全国的に代表的なサンプルにおける死亡率の有意な予測因子である.
- これらの発見は,リスクの階層化において脈圧を考慮することの重要性を強調し,ESRDにおける血管機能の治療的影響に関するさらなる研究を提案しています.
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