BACKGROUND Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients. METHODS We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease. RESULTS The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05-9.37]. CONCLUSIONS IDH was an independent risk factor for incident CLI in patients on HD.

中文翻译：

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透析内低血压是血液透析患者严重肢体缺血的重要危险因素。

背景技术严重肢体缺血（CLI）和透析内低血压（IDH）是血液透析（HD）患者的常见并发症。但是，关于这些患者中IDH是否与CLI相关的数据有限。这项回顾性研究的目的是评估IDH是否是HD患者CLI的危险因素。方法我们调查了147例2012年1月1日至6月30日接受HD的患者的IDH频率。HD每30分钟测量一次血压，IDH定义为收缩压下降≥20 mmHg，而之前30分钟和最低的透析内收缩压<90 mmHg。主要研究结果是新开发的CLI，需要进行血管重建治疗或与CLI相关的死亡。我们通过对男性，年龄，吸烟和心血管疾病病史进行调整的多变量亚分布危害模型，评估了IDH与预后的相关性。结果中位随访期为24.5个月。在研究进入期，有50名患者（34％）出现了IDH发作。在随访期间，有14例患者接受了血管内治疗，其中1例患者发生了CLI相关的死亡。单因素分析中与事件CLI相关的因素是年龄，吸烟，糖尿病，外周动脉疾病，心血管疾病史和IDH。IDH与结果显着相关，子分布风险比为3.13 [95％置信区间，1.05-9.37]。结论IDH是HD患者发生CLI的独立危险因素。吸烟和心血管疾病史。结果中位随访期为24.5个月。在研究进入期，有50名患者（34％）出现了IDH发作。在随访期间，有14例患者接受了血管内治疗，其中1例患者发生了CLI相关的死亡。在单因素分析中与事件CLI相关的因素是年龄，吸烟，糖尿病，外周动脉疾病，心血管疾病史和IDH。IDH与结果显着相关，子分布风险比为3.13 [95％置信区间，1.05-9.37]。结论IDH是HD患者发生CLI的独立危险因素。吸烟和心血管疾病史。结果中位随访期为24.5个月。在研究进入期，有50名患者（34％）出现了IDH发作。在随访期间，有14例患者接受了血管内治疗，其中1例患者发生了CLI相关的死亡。在单因素分析中与事件CLI相关的因素是年龄，吸烟，糖尿病，外周动脉疾病，心血管疾病史和IDH。IDH与结果显着相关，子分布风险比为3.13 [95％置信区间，1.05-9.37]。结论IDH是HD患者发生CLI的独立危险因素。14例患者接受了血管内治疗，其中1例患者发生了CLI相关的死亡。单因素分析中与事件CLI相关的因素是年龄，吸烟，糖尿病，外周动脉疾病，心血管疾病史和IDH。IDH与结果显着相关，子分布风险比为3.13 [95％置信区间，1.05-9.37]。结论IDH是HD患者发生CLI的独立危险因素。14例患者接受了血管内治疗，其中1例患者发生了CLI相关的死亡。在单因素分析中与事件CLI相关的因素是年龄，吸烟，糖尿病，外周动脉疾病，心血管疾病史和IDH。IDH与结果显着相关，子分布风险比为3.13 [95％置信区间，1.05-9.37]。结论IDH是HD患者发生CLI的独立危险因素。