The characteristics of blood pressure variability in maintenance hemodialysis patients with and without diabetes mellitus and its effects on cardiac function_West China Medical Journal

Authors：

ZHAO Caixia , CAO Juan ,  ZHANG Xu , LI Haitao , WEI Zhiqiang , YIN Di , ZHOU Changju , XU Qin

Department of Nephrology, People’s Hospital of Taixing City, Taixing, Jiangsu 225400, P. R. China;

Corresponding author：

ZHANG Xu, Email: dr.zhangxu@aliyun.com

Keywords：

Diabetes mellitus; Maintenance hemodialysis; Blood pressure variability; Cardiac function

DOI：

10.7507/1002-0179.201509096

Video：

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Objective To explore the characteristics of blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients with and without diabetes mellitus and the effects of BPV on cardiac function based on the research of clinical data. Methods One hundred MHD patients treated in the Hemodialysis Center of the People’s Hospital of Taixing City between January 2013 and January 2015 were recruited and divided into diabetes group (n=46) and non-diabetes group (n=54). Interdialytic and intradialytic BPV and cardiac function were monitored and compared between the two groups. Standard deviation (SD) and coefficient of variation (CV) were used for the evaluation of BPV. Results Triacylglycerol, cholesterol and plasma albumin were significantly different between the diabetes group and non-diabetes group (P<0.05), while hemoglobin, serum calcium, phosphorus and parathyroid hormone were not significantly different between the two groups (P>0.05). Forty-two patients in the diabetes group and 53 in the non-diabetes group took antihypertensive drugs. The varieties of antihypertensive drugs and the proportion of patients who used antihypertensive drugs were not significantly different between the two groups. The ambulatory blood pressure monitoring displayed 40 patients (86.9%) with reverse dipper or non-dipper blood pressure in the diabetes group and 35 (64.8%) in the non-diabetes group, and the difference was significant (P<0.05). The interdialytic mean systolic blood pressure (SBP), SBP-SD and SBP-CV in the diabetes group were all significantly higher than those in the non-diabetes group (P<0.05), and the mean diastolic blood pressure (DBP), DBP-SD and DBP-CV were also significantly different between the two groups (P<0.05). The intradialytic mean SBP, SBP-SD and SBP-CV in the diabetes group were significantly higher than those in the non-diabetes group (P<0.05), but there were no significant differences in intradialytic mean DBP, DBP-SD and DBP-CV between the two groups. In patients with reverse dipper or non-dipper blood pressure, the interventricular septal thickness, left ventricular end-diastolic diameter and ejection fraction were significantly different between the diabetes group and the non-diabetes group. However, in patients with dipper blood pressure, the cardiac function parameters were not significantly different between the two groups. Conclusion MHD patients with diabetes have higher ratio of reverse dipper or non-dipper blood pressure, more significant blood pressure variability and more severe cardiac function damage.

Citation： ZHAOCai-xia, CAOJuan, ZHANGXu, LIHai-tao, WEIZhi-qiang, YINDi, ZHOUChang-ju, XUQin. The characteristics of blood pressure variability in maintenance hemodialysis patients with and without diabetes mellitus and its effects on cardiac function. West China Medical Journal, 2017, 32(2): 174-178. doi: 10.7507/1002-0179.201509096 Copy

1.	Collins J, Foley N, Chavers B, et al. United States renal data system 2011 annual data report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis, 2012, 59(1 Suppl 1): A7, e1-420.
2.	Liu W, Ye H, Tang B, et al. Profile of interdialytic ambulatory blood pressure in a cohort of Chinese patients. J Hum Hypertens, 2014, 28(11): 677-683.
3.	谷立杰, 张郁苒, 袁伟杰, 等. 维持性血液透析患者透析中血压变异性的相关因素及其对预后的影响. 中华内科杂志, 2013, 52(6): 453-458.
4.	刘静, 王丽妍, 郑力仁, 等. 维持性血液透析患者血压变异性对心功能的影响及相关因素分析. 临床和实验医学杂志, 2013, 12(7): 484-487.
5.	Di Iorio B, Di Micco L, Torraca S, et al. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk?. J Nephrol, 2013, 26(1): 173-182.
6.	Rossignol P, Cridlig J, Lehert P, et al. Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSlDIAL. Hypertension, 2012, 60(2): 339-346.
7.	Flythe JE, Inrig JK, Shafi T, et al. Association of intradialytic blood pressure variabilitv with increased all-cause and cardiovascular mortalitv in patients treated with long-term hemodialysis. Am J Kidney Dis, 2013, 61(6): 966-974.
8.	刘江, 徐萍飞, 杨金国, 等. 糖尿病肾病与非糖尿病肾病血液透析中急慢性并发症临床分析. 实用医学杂志, 2009, 25(24): 4172-4173.
9.	Osthus TB, von der Lippe N, Ribu L, et al. Health-related quality of life and all-cause mortality in patients with diabetes on dialysis. BMC Nephrol, 2012, 13: 78.
10.	曾辉. 糖尿病肾病与非糖尿病肾病患者维持性血液透析生存率对比分析. 黑龙江医学, 2013, 37(12): 1170-1171.
11.	李秀季, 姜立萍, 黄雯. 血液透析糖尿病与非糖尿病患者血压变异性的比较. 中国血液净化, 2012, 11(4): 206-209.
12.	Matsumae T, Abe Y, Murakami G, et al. Effects of glucose metabolism on aortic pulse wave velocity in hemodialysis patients with and without diabetes, Hypertens Res, 2008, 31(7): 1365-1372.
13.	刘宁, 黄雯, 姜立萍. 糖尿病与非糖尿病维持性血液透析患者内皮细胞损伤和组织因子变化分析. 中国血液净化, 2012, 11(9): 489-492.
14.	李萌萌, 赵战云, 郭爱, 等. 糖尿病与非糖尿病维持性血液透析患者血管内皮生长因子与髓过氧化物酶的对比研究. 中国医师进修杂志, 2015, 38(5): 359-362.
15.	Nedoboy PE, Morgan PE, Mocatta TJ, et al. High plasma thiocyanate levels are associated with enhanced myeloperoxidase-induced thiol oxidation and long-term survival in subjects following a first myocardial infarction. Free Radic Res, 2014, 48(10): 1256-1266.
16.	Flythe JE, Kunaparaju S, Dinesh K, et al. Factors associated with intradialytie systolic blood pressure variability. Am J Kidney Dis, 2012, 59(3): 409-418.
17.	Murashima M, Kumar D, Doyle AM, et al. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int, 2010, 14(3): 270-277.
18.	Webb AJ, Rothwell PM. Effect of dose and combination of antihypertensives on interindividual blood pressure variability a systematic review. Stroke, 2011, 42(10): 2860-2865.
19.	Liu W, Ye H, Tang B, et al. Profile of interdialytic ambulatory blood pressure in a cohort of Chinese patients. J Hum Hypertens, 2014, 28(11): 677-683.
20.	Hermida RC, Ayala DE, Smolensky MH, et al. Chronotherapy improves blood pressure control and reduces vascular risk in CKD. Nat Rev Nephrol, 2013, 9(6): 358-368.

1. Collins J, Foley N, Chavers B, et al. United States renal data system 2011 annual data report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis, 2012, 59(1 Suppl 1): A7, e1-420.
2. Liu W, Ye H, Tang B, et al. Profile of interdialytic ambulatory blood pressure in a cohort of Chinese patients. J Hum Hypertens, 2014, 28(11): 677-683.
3. 谷立杰, 张郁苒, 袁伟杰, 等. 维持性血液透析患者透析中血压变异性的相关因素及其对预后的影响. 中华内科杂志, 2013, 52(6): 453-458.
4. 刘静, 王丽妍, 郑力仁, 等. 维持性血液透析患者血压变异性对心功能的影响及相关因素分析. 临床和实验医学杂志, 2013, 12(7): 484-487.
5. Di Iorio B, Di Micco L, Torraca S, et al. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk?. J Nephrol, 2013, 26(1): 173-182.
6. Rossignol P, Cridlig J, Lehert P, et al. Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSlDIAL. Hypertension, 2012, 60(2): 339-346.
7. Flythe JE, Inrig JK, Shafi T, et al. Association of intradialytic blood pressure variabilitv with increased all-cause and cardiovascular mortalitv in patients treated with long-term hemodialysis. Am J Kidney Dis, 2013, 61(6): 966-974.
8. 刘江, 徐萍飞, 杨金国, 等. 糖尿病肾病与非糖尿病肾病血液透析中急慢性并发症临床分析. 实用医学杂志, 2009, 25(24): 4172-4173.
9. Osthus TB, von der Lippe N, Ribu L, et al. Health-related quality of life and all-cause mortality in patients with diabetes on dialysis. BMC Nephrol, 2012, 13: 78.
10. 曾辉. 糖尿病肾病与非糖尿病肾病患者维持性血液透析生存率对比分析. 黑龙江医学, 2013, 37(12): 1170-1171.
11. 李秀季, 姜立萍, 黄雯. 血液透析糖尿病与非糖尿病患者血压变异性的比较. 中国血液净化, 2012, 11(4): 206-209.
12. Matsumae T, Abe Y, Murakami G, et al. Effects of glucose metabolism on aortic pulse wave velocity in hemodialysis patients with and without diabetes, Hypertens Res, 2008, 31(7): 1365-1372.
13. 刘宁, 黄雯, 姜立萍. 糖尿病与非糖尿病维持性血液透析患者内皮细胞损伤和组织因子变化分析. 中国血液净化, 2012, 11(9): 489-492.
14. 李萌萌, 赵战云, 郭爱, 等. 糖尿病与非糖尿病维持性血液透析患者血管内皮生长因子与髓过氧化物酶的对比研究. 中国医师进修杂志, 2015, 38(5): 359-362.
15. Nedoboy PE, Morgan PE, Mocatta TJ, et al. High plasma thiocyanate levels are associated with enhanced myeloperoxidase-induced thiol oxidation and long-term survival in subjects following a first myocardial infarction. Free Radic Res, 2014, 48(10): 1256-1266.
16. Flythe JE, Kunaparaju S, Dinesh K, et al. Factors associated with intradialytie systolic blood pressure variability. Am J Kidney Dis, 2012, 59(3): 409-418.
17. Murashima M, Kumar D, Doyle AM, et al. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int, 2010, 14(3): 270-277.
18. Webb AJ, Rothwell PM. Effect of dose and combination of antihypertensives on interindividual blood pressure variability a systematic review. Stroke, 2011, 42(10): 2860-2865.
19. Liu W, Ye H, Tang B, et al. Profile of interdialytic ambulatory blood pressure in a cohort of Chinese patients. J Hum Hypertens, 2014, 28(11): 677-683.
20. Hermida RC, Ayala DE, Smolensky MH, et al. Chronotherapy improves blood pressure control and reduces vascular risk in CKD. Nat Rev Nephrol, 2013, 9(6): 358-368.

West China Medical Journal

The characteristics of blood pressure variability in maintenance hemodialysis patients with and without diabetes mellitus and its effects on cardiac function

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