1
|
Lin CJ, Chen CY, Wu PC, Pan CF, Shih HM, Huang MY, Chou LH, Tang JS, Wu CJ. Intelligent system to predict intradialytic hypotension in chronic hemodialysis. J Formos Med Assoc 2018; 117:888-893. [PMID: 29941330 DOI: 10.1016/j.jfma.2018.05.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/22/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intradialytic hypotension (IDH) is a serious complication and a major risk factor of increased mortality during hemodialysis (HD). However, predicting the occurrence of intradialytic blood pressure (BP) fluctuations clinically is difficult. This study aimed to develop an intelligent system with capability of predicting IDH. METHODS In developing and training the prediction models in the intelligent system, we used a database of 653 HD outpatients who underwent 55,516 HD treatment sessions, resulting in 285,705 valid BP records. We built models to predict IDH at the next BP check by applying time-dependent logistic regression analyses. RESULTS Our results showed the sensitivity of 86% and specificity of 81% for both nadir systolic BP (SBP) of <90 mmHg and <100 mmHg, suggesting good performance of our prediction models. We obtained similar results in validating via test data and data of newly enrolled patients (new-patient data), which is important for simulating prospective situations wherein dialysis staff are unfamiliar with new patients. This compensates for the retrospective nature of the BP records used in our study. CONCLUSION The use of this validated intelligent system can identify patients who are at risk of IDH in advance, which may facilitate well-timed personalized management and intervention.
Collapse
Affiliation(s)
- Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chih-Yang Chen
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Pei-Chen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chi-Feng Pan
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hong-Mou Shih
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Yuan Huang
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Li-Hua Chou
- Division of Hemodialysis and Peritoneal Dialysis, Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jin-Sheng Tang
- Department of Information Technology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| |
Collapse
|
2
|
Aftab RA, Khan AH, Adnan AS, Sulaiman SAS, Khan TM. Safety and Efficacy of Losartan 50 mg in Reducing Blood Pressure among Patients with Post-Dialysis Euvolemic Hypertension: A Randomized Control Trial. Sci Rep 2017; 7:17741. [PMID: 29255272 PMCID: PMC5735086 DOI: 10.1038/s41598-017-17437-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of current study was to assess the effectiveness of losartan 50 mg in reducing blood pressure among post-dialysis euvolemic hypertensive patients, observing their survival trends and adverse events during the course of study. A multicentre, prospective, randomised, single-blind trial was conducted to assess the effect of losartan 50 mg every other day (EOD), once a morning (OM) among post-dialysis euvolemic hypertensive patients. Post-dialysis euvolemic assessment was done by a body composition monitor (BCM). Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm. Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard and intervention arms. After follow-up of 12 months’ pre-dialysis systolic (p < 0.001) and diastolic (p 0.01), intradialysis diastolic (p 0.02), post-dialysis systolic (p < 0.001) and diastolic (p < 0.001) blood pressure was reduced from the baseline among intervention-arm patients Compared to only pre-dialysis systolic blood pressure (p 0.003) among standard arm patients after 12 months of follow. Total of six deaths were reported among standard-arm patients compared to 2 deaths among the intervention arm. Losartan 50 mg achieve an overall significant decline in blood pressure among post-dialysis euvolemic hypertensive patients.
Collapse
Affiliation(s)
- Raja Ahsan Aftab
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia. .,CKD Resource Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
| | - Azreen Syazril Adnan
- CKD Resource Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 45700, Selangor, Malaysia.,Department of Pharmacy, Abasyn University, Peshawar, Pakistan
| |
Collapse
|