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浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (2): 180-185    DOI: 10.3785/j.issn.1008-9292.2019.04.09
    
Associations of mean arterial pressure levels with mortality in patients with peritoneal dialysis
LYU Duo1,2(),XIE Xishao1,ZHANG Xiaohui1,CHEN Jianghua1,*()
1. Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Clinical Pharmacy Research Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Abstract  

Objective: To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD). Methods: A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. Results: During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95- < 120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (HR=1.40, 95%CI:1.01-1.93, P < 0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (HR=2.12, 95%CI:1.32-3.40, P < 0.01) and cardiovascular morality (HR=2.55, 95%CI:1.38-4.70, P < 0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality. Conclusion: Both high MAP and low MAP are associated with higher risk of mortality in PD patients.

Key words： Kidney failure, chronic/therapy      Peritoneal dialysis      Arterial pressure      Death      Cardiovascular diseases      Retrospective studies     
Received: 10 January 2019      Published: 24 July 2019
CLC:  R459.5  
Corresponding Authors: CHEN Jianghua     E-mail: lvduo8905@zju.edu.cn;zjukidney@zju.edu.cn
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LYU Duo
XIE Xishao
ZHANG Xiaohui
CHEN Jianghua
Cite this article:

LYU Duo,XIE Xishao,ZHANG Xiaohui,CHEN Jianghua. Associations of mean arterial pressure levels with mortality in patients with peritoneal dialysis. J Zhejiang Univ (Med Sci), 2019, 48(2): 180-185.

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http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.04.09     OR     http://www.zjujournals.com/med/Y2019/V48/I2/180


腹膜透析患者平均动脉压水平与死亡的关系

目的: 探讨腹膜透析患者平均动脉压（MAP）水平与患者预后之间的关系。方法: 回顾性分析2008至2016年在浙江大学医学院附属第一医院开始腹膜透析的1737例终末期肾病患者的平均MAP水平，随访33.0（19.3，52.4）个月。取腹膜透析开始3个月内的MAP平均值作为基线MAP值。通过Cox比例风险模型和分数多项式回归模型分析MAP水平与腹膜透析患者全因死亡和心脑血管死亡之间的关系。结果: 随访过程中共有208例患者死亡，其中因心脑血管原因死亡95例，占45.7%。相比于MAP>95~ < 120 mmHg的腹膜透析患者，MAP ≤ 95 mmHg的腹膜透析患者全因死亡风险增高（HR=1.40，95%CI：1.01~1.93，P < 0.05），MAP ≥ 120 mmHg的患者全因死亡（HR=2.12，95%CI：1.32~3.40，P < 0.01）和心脑血管死亡风险均明显增高（HR=2.55，95%CI：1.38~4.70，P < 0.01）。腹膜透析患者MAP水平与患者全因死亡呈"U"型关系，与心脑血管死亡呈"J"型关系。结论: 高MAP和低MAP水平均会增加患者死亡的风险。


关键词： 肾功能衰竭, 慢性/治疗,  腹膜透析,  动脉压,  死亡,  心血管疾病,  回顾性研究 
[$\bar x \pm s$、n(%)或M(Q1，Q3)]
MAP水平分组 n 年龄 男性(%) 体质指数 小学及以下(%) MAP(mmHg) 糖尿病 心血管疾病 脑血管疾病 血红蛋白(g/L) 血清白蛋白(g/L) 残肾肾小球滤过率(mL·min-1·1.73m-2)
“—”无相关数据.1 mmHg=0.133 kPa.
≤95 mmHg组 375 54±16 185(49.3) 20.9±3.4 304(43.9) 88±6 71(18.9) 60(16.0) 10(2.7) 93±14 38.2±4.7 4.7(2.9, 7.0)
＞95~ < 120 mmHg组 1202 48±14 703(58.5) 21.4±3.2 47(29.4) 107±6 157(13.1) 132(11.0) 45(3.7) 94±12 37.9±4.6 4.6(3.0, 6.5)
≥120 mmHg组 160 43±14 97(60.6) 21.8±3.2 738(41.4) 125±6 12(7.5) 30(18.8) 10(6.3) 93±15 37.2±5.2 3.8(2.1, 6.2)
χ2/F值 — 38.984 10.855 6.254 17.258 2227.094 14.181 12.091 3.998 1.048 2.724 7.063
P值 — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 ＞0.05 ＞0.05 ＞0.05 < 0.05
Tab 1 Clinical characteristics of patients with different levels of mean arterial pressure(MAP)
[n(%)]
MAP水平分组 n 慢性肾小球肾炎 糖尿病肾病 高血压肾病 梗阻性肾病 多囊肾 其他
“—”无相关数据.1 mmHg=0.133 kPa.
≤95 mmHg组 375 219(58.4) 64(17.1) 18(4.8) 7(1.9) 16(4.3) 51(13.5)
＞95~ < 120 mmHg组 1202 758(63.1) 144(12.0) 62(5.2) 22(1.8) 17(1.4) 199(16.5)
≥120 mmHg组 160 112(70.0) 10(6.3) 11(6.9) 0(0.0) 2(1.3) 25(15.5)
χ2/F值 — 6.677 13.112 1.024 2.995 12.301 1.880
P值 — < 0.05 < 0.01 ＞0.05 ＞0.05 < 0.01 ＞0.05
Tab 2 Primary kidney diseases of patients with different levels of mean arterial pressure (MAP)
[n(%)]
MAP水平分组 n ACEI/ARB β受体阻滞剂 钙通道阻滞剂 α受体阻滞剂 利尿剂
“—”无相关数据.ACEI:血管紧张素转化酶抑制剂；ARB:血管紧张素Ⅱ受体拮抗剂；1 mmHg=0.133 kPa.
≤95 mmHg组 375 64(17.1) 218(58.1) 125(33.3) 28(7.5) 95(25.3)
＞95~ < 120 mmHg组 1202 449(37.4) 868(72.2) 622(51.8) 125(10.4) 316(26.3)
≥120 mmHg组 160 86(53.8) 119(74.4) 79(49.4) 23(14.4) 42(26.3)
χ2/F值 — 81.023 28.744 39.093 6.183 0.138
P值 — < 0.01 < 0.01 < 0.01 < 0.05 ＞0.05
Tab 3 Drug use in patient with different levels of mean arterial pressure (MAP)
[HR(95%CI)]
MAP水平分组 n 全因死亡 心脑血管死亡
模型1 模型2 模型3 模型4 模型1 模型2 模型3 模型4
模型1为未校正；模型2校正年龄、性别、合并症、体质指数、原发疾病；模型3校正模型2中的因素以及血红蛋白、血白蛋白及残肾肾小球滤过率；模型4校正模型3中的因素以及降压药物和利尿剂.1 mmHg=0.133 kPa.
≤95 mmHg组 375 1.85(1.38~2.49) 1.26(0.93~1.71) 1.35(0.99~1.85) 1.40(1.01~1.93) 1.40(0.88~2.25) 1.04(0.88~1.69) 1.06(0.65~1.74) 1.08(0.65~1.79)
＞95~ < 120 mmHg组 1202 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
≥120 mmHg组 160 1.59(1.01~2.51) 2.11(1.33~3.36) 2.07(1.30~3.30) 2.12(1.32~3.40) 2.12(1.18~3.81) 2.55(1.40~4.65) 2.56(1.40~4.68) 2.55(1.38~4.70)
Tab 4 Associations of mean arterial pressure (MAP) with all-cause and cardiovascular mortality
Fig 1 Fractional polynomials model for mean arterial pressure and all-cause mortality in peritoneal dialysis
Fig 2 Fractional polynomials model for mean arterial pressure and cardiovascular mortality in peritoneal dialysis
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