The risk factors for intradialytic systolic blood pressure decline remain poorly understood. We aimed to identify clinical and laboratory predictors of the intradialytic systolic blood pressure decline, considering its seasonal variation. In a retrospective cohort of 47,219 hemodialysis sessions of 307 patients undergoing hemodialysis over one year in three dialysis clinics, the seasonal variation and the predictors of intradialytic systolic blood pressure decline (predialysis systolic blood pressure––nadir intradialytic systolic blood pressure) were assessed using cosinor analysis and linear mixed models adjusted for baseline or monthly hemodialysis-related variables, respectively. The intradialytic systolic blood pressure decline was greatest and least in the winter and summer, respectively, showing a clear seasonal pattern. In both models adjusted for baseline and monthly hemodialysis-related parameters, calcium channel blocker use was associated with a smaller decline (−4.58 [95% confidence interval (CI), −5.84 to −3.33], P < 0.001; −3.66 [95% CI, −5.69 to −1.64], P < 0.001) and α blocker use, with a greater decline (3.25 [95% CI, 1.53–4.97], P < 0.001; 3.57 [95% CI, 1.08–6.06], P = 0.005). Baseline and monthly serum phosphorus levels were positively correlated with the decline (1.55 [95% CI, 0.30–2.80], P = 0.02; 0.59 [95% CI, 0.16–1.00], P = 0.007), and baseline and monthly normalized protein catabolic rates were inversely correlated (respectively, −22.41 [95% CI, −33.53 to −11.28], P < 0.001; 9.65 [95% CI, 4.60–14.70], P < 0.001). In conclusion, calcium channel blocker use, α blocker avoidance, and serum phosphorus-lowering therapy may attenuate the intradialytic systolic blood pressure decline and should be investigated in prospective trials.

透析中收缩压下降的危险因素仍然知之甚少。考虑到季节性变化，我们的目的是确定透析中收缩压下降的临床和实验室预测因子。在三个透析诊所的 307 名接受血液透析超过一年的患者的 47,219 次血液透析疗程的回顾性队列中，使用余弦评估季节性变化和透析中收缩压下降的预测因子（透析前收缩压 - 透析中收缩压最低值）分析和线性混合模型分别针对基线或每月血液透析相关变量进行调整。透析中收缩压下降幅度在冬季和夏季分别最大和最小，呈现出明显的季节性模式。P  < 0.001；-3.66 [95% CI，-5.69 至 -1.64]，P  < 0.001）和 α 受体阻滞剂的使用，下降幅度更大（3.25 [95% CI，1.53–4.97]，P  < 0.001；3.57 [95% CI，1.08 –6.06]，P  = 0.005）。基线和每月血清磷水平与下降呈正相关（1.55 [95% CI，0.30–2.80]，P  = 0.02；0.59 [95% CI，0.16–1.00]，P  = 0.007），以及基线和每月标准化蛋白质分解代谢率呈负相关（分别为 -22.41 [95% CI，-33.53 至 -11.28]，P  < 0.001；9.65 [95% CI，4.60-14.70]，P < 0.001)。总之，钙通道阻滞剂的使用、α 阻滞剂的避免和血清磷降低治疗可能会减弱透析中收缩压的下降，应在前瞻性试验中进行研究。