BACKGROUND Although the dynamics of blood pressure (BP) during dialysis provide information related to the control system, the prognosis and relationships between temporal changes in intradialytic hemodynamic regulation, BP, and decreased cardiac function remain largely unclear. METHODS Hemodynamic parameters, including heart rate (HR), stroke volume (SV), cardiac index, and systemic vascular resistance index, were recorded using a noninvasive hemodynamic device on a beat-by-beat basis in 40 patients on dialysis who were divided into three groups, i.e., those with and without BP lability and those with heart failure (HF). Statistical measurements, including mean, standard deviation, coefficient of variation (CV), and index of nonrandomness of each hemodynamic parameter were derived from the three different phases divided equally during dialysis and compared using 3×3 two-way mixed-model analysis of variance to determine the effects of the different stages of hemodialysis (HD), cardiac function, and intradialytic changes in BP on the hemodynamic parameters. In addition, multivariate Cox regression was performed to determine the association between the changes in the derived parameters and BP lability. RESULTS The average SV tended to decrease during HD in all groups (p = 0.041). A significant decrease was observed in the CV of SV between the first two stages of HD in patients with labile BP and HF when compared to those without labile BP (p = 0.037). Significant interactions between group and stage of the index of nonrandomness for HR were also noted; this index was significantly higher in patients without labile BP than in those with labile BP or HF (p = 0.048). A higher difference between the early and middle stages of HD for nonrandomness indexes of HR was an independent predictor of reduced BP lability during HD (HR = 0.844, 95% confidence interval 0.722-0.987, p = 0.034). CONCLUSIONS Increases in the CV of SV and the index of nonrandomness for HR during early-stage HD in response to decreased SV may be associated with better BP control during HD. This finding suggests that patients with more structurally meaningful hemodynamic control have a more favorable cardiovascular outcome.

中文翻译：

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有和无心力衰竭患者血液透析期间的无创血流动力学特征。

背景尽管透析过程中的血压 (BP) 动态提供了与控制系统相关的信息，但透析中血流动力学调节的时间变化、BP 和心脏功能下降之间的预后和关系仍不清楚。方法 使用无创血流动力学装置逐次记录 40 例透析患者的血流动力学参数，包括心率（HR）、每搏输出量（SV）、心脏指数和全身血管阻力指数。三组，即有和没有血压不稳定性和心力衰竭（HF）。统计测量，包括平均值、标准偏差、变异系数 (CV)、各血流动力学参数的非随机性和非随机性指数来源于透析过程中等分的三个不同阶段，并使用 3×3 双向混合模型方差分析进行比较，以确定血液透析 (HD) 不同阶段、心功能的影响和透析中血压对血液动力学参数的变化。此外，还进行了多变量 Cox 回归以确定衍生参数的变化与血压不稳定性之间的关联。结果 HD 期间所有组的平均 SV 趋于降低 (p = 0.041)。与没有不稳定血压的患者相比，血压不稳定和 HF 患者在 HD 前两个阶段之间的 SV CV 显着降低（p = 0.037）。还注意到 HR 非随机性指数的组和阶段之间的显着相互作用；该指数在没有血压不稳定的患者中显着高于血压不稳定或心衰患者（p = 0.048）。HD 早期和中期 HR 非随机性指标的较大差异是 HD 期间血压不稳定性降低的独立预测因子（HR = 0.844，95% 置信区间 0.722-0.987，p = 0.034）。结论 早期 HD 期间 SV 的 CV 和 HR 的非随机性指数随着 SV 降低而增加，这可能与 HD 期间更好的血压控制有关。这一发现表明，血流动力学控制在结构上更有意义的患者具有更有利的心血管结局。HD 早期和中期 HR 非随机性指标的较大差异是 HD 期间血压不稳定性降低的独立预测因子（HR = 0.844，95% 置信区间 0.722-0.987，p = 0.034）。结论 早期 HD 期间 SV 的 CV 和 HR 的非随机性指数随着 SV 降低而增加，这可能与 HD 期间更好的血压控制有关。这一发现表明，血流动力学控制在结构上更有意义的患者具有更有利的心血管结局。HD 早期和中期 HR 非随机性指标的较大差异是 HD 期间血压不稳定性降低的独立预测因子（HR = 0.844，95% 置信区间 0.722-0.987，p = 0.034）。结论 早期 HD 期间 SV 的 CV 和 HR 的非随机性指数随着 SV 降低而增加，这可能与 HD 期间更好的血压控制有关。这一发现表明，血流动力学控制在结构上更有意义的患者具有更有利的心血管结局。