Risk factor analysis for hypotension during double plasma molecular adsorption system therapy in hepatic failure patients_West China Medical Journal

Authors：

ZHAO Yuan ¹ , LIN Li ¹ , WANG Fang ¹ , HE Yingying ¹ , TANG Xue ¹ , CHEN Zhiwen ¹ ,  ZHANG Ling ²

1. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHANG Ling, Email: zhangling_crrt@163.com

Keywords：

Hepatic failure; double plasma molecular adsorption system; hypotension; risk factor

DOI：

10.7507/1002-0179.202506125

Video：

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Objective To investigate the risk factors for hypotension in liver failure patients during double plasma molecular adsorption system (DPMAS) treatment, providing a theoretical basis for targeted clinical prevention and intervention. Methods Liver failure patients undergoing DPMAS at West China Hospital of Sichuan University between March 2021 and March 2023 were retrospectively enrolled. General data and clinical indicators were compared between the hypotension group and non-hypotension group. Multivariate logistic regression analysis was used to identify risk factors for hypotension. Results Of the 403 included patients, 60 (14.89%) developed hypotension, while 343 (85.11%) did not. Univariate analyses showed statistically significant differences between groups in age, sex, body mass index (BMI), albumin, serum sodium, pre-treatment systolic blood pressure, pre-treatment diastolic blood pressure, pre-treatment mean arterial pressure, and intraoperative vasoactive drug use (P<0.05). Multivariate logistic regression revealed that low BMI [odds ratio (OR)=0.712, 95% confidence interval (CI) (0.587, 0.863)], low serum sodium [OR=0.715, 95%CI (0.646, 0.792)], and intraoperative vasoactive drug use [OR=11.382, 95%CI (4.438, 29.194)] were independent risk factors for hypotension (P<0.05). Receiver operating characteristic curve analysis combining these three factors yielded an area under the curve of 0.922 [95%CI (0.886, 0.957)] for predicting hypotension incidence. Conclusions Low serum sodium, intraoperative vasoactive drug use, and low BMI are significant risk factors for hypotension during DPMAS therapy. Clinical emphasis should be placed on anticipating and mitigating hypotension to ensure uninterrupted treatment, reduce economic burdens, and improve patient prognosis.

Citation： ZHAO Yuan, LIN Li, WANG Fang, HE Yingying, TANG Xue, CHEN Zhiwen, ZHANG Ling. Risk factor analysis for hypotension during double plasma molecular adsorption system therapy in hepatic failure patients. West China Medical Journal, 2025, 40(7): 1078-1083. doi: 10.7507/1002-0179.202506125 Copy

1.	陳香美. 血液凈化操作規程. 北京: 人民衛生出版社, 2021: 186-187.
2.	中華醫學會肝病學分會重型肝病與人工肝學組. 人工肝血液凈化技術臨床應用專家共識(2022 年版). 實用肝臟病雜志, 2022, 25(3): 457-468.
3.	中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診治指南(2018 年版). 中華肝臟病雜志, 2019, 27(1): 18-26.
4.	中華醫學會器官移植學分會圍手術期管理學組. 肝衰竭肝移植圍手術期管理中國專家共識(2021 版). 中華消化外科雜志, 2021, 20(8): 835-840.
5.	Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol, 2008, 19(1): 8-11.
6.	McIntyre CW, Goldsmith DJ. Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension?. Kidney Int, 2015, 87(6): 1109-1115.
7.	王建華. 實用醫學科研方法. 2 版. 北京: 人民衛生出版社, 2003: 56-57.
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9.	中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診治指南(2024 年版). 臨床肝膽病雜志, 2024, 40(12): 2371-2387.
10.	Kanbay M, Ertuglu LA, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J, 2020, 13(6): 981-993.
11.	Stefánsson BV, Brunelli SM, Cabrera C, et al. Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol, 2014, 9(12): 2124-2132.
12.	Singh AT, Mc Causland FR. Osmolality and blood pressure stability during hemodialysis. Semin Dial, 2017, 30(6): 509-517.
13.	Ma S, Xie Z, Zhang H, et al. Characterization of an artificial liver support system-related vasovagal reaction. Biomed Res Int, 2020, 2020: 6313480.
14.	Chang TI, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol, 2011, 22(8): 1526-1533.
15.	劉尋, 王曉菲, 張婷, 等. 血液透析中低血壓臨床分析. 中國血液凈化, 2021, 20(1): 50-53.
16.	Pinter J, Smyth B, Stuard S, et al. Effect of dialysate and plasma sodium on mortality in a global historical hemodialysis cohort. J Am Soc Nephrol, 2024, 35(2): 167-176.
17.	Kuipers J, Verboom LM, Ipema KJR, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis. Am J Nephrol, 2019, 49(6): 497-506.
18.	Arasnezhad M, Namazinia M, Mazlum SR, et al. The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study. BMC Nephrol, 2024, 25(1): 128.
19.	Ettema EM, Kuipers J, van Faassen M, et al. Effect of plasma sodium concentration on blood pressure regulators during hemodialysis: a randomized crossover study. BMC Nephrol, 2018, 19(1): 214.
20.	Praharaj DL, Anand AC. Clinical implications, evaluation, and management of hyponatremia in cirrhosis. J Clin Exp Hepatol, 2022, 12(2): 575-594.
21.	黃冬清, 羅珍玉, 黃小知, 等. 中青年體檢人群體質量指數與血糖和血脂及血壓相關性分析. 臨床醫藥實踐, 2022, 31(1): 55-58.
22.	Li Y, Wright MD. Patient positioning during a hypotensive episode for adults undergoing hemodialysis: a review of clinical effectiveness and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2020.
23.	潘姚佳, 傅方琳, 韓正, 等. 肥胖類型與心血管代謝性共病的關系: 基于不同性別的中年居民. 中國全科醫學, 2025, 28(18): 2285-2293.
24.	孫偉航, 張驁丹, 李巍. 預后營養指數聯合磁共振表觀擴散系數在肝細胞癌肝動脈化療栓塞中的臨床應用價值. 中華醫學雜志, 2019, 99(33): 2581-2585.
25.	余玲, 呂麗敏, 陳亞丹. 臨床護士《血管活性藥物靜脈輸注護理》團體標準的執行情況. 中國衛生標準管理, 2023, 14(7): 7-12.

1. 陳香美. 血液凈化操作規程. 北京: 人民衛生出版社, 2021: 186-187.
2. 中華醫學會肝病學分會重型肝病與人工肝學組. 人工肝血液凈化技術臨床應用專家共識(2022 年版). 實用肝臟病雜志, 2022, 25(3): 457-468.
3. 中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診治指南(2018 年版). 中華肝臟病雜志, 2019, 27(1): 18-26.
4. 中華醫學會器官移植學分會圍手術期管理學組. 肝衰竭肝移植圍手術期管理中國專家共識(2021 版). 中華消化外科雜志, 2021, 20(8): 835-840.
5. Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol, 2008, 19(1): 8-11.
6. McIntyre CW, Goldsmith DJ. Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension?. Kidney Int, 2015, 87(6): 1109-1115.
7. 王建華. 實用醫學科研方法. 2 版. 北京: 人民衛生出版社, 2003: 56-57.
8. Flythe JE, Xue H, Lynch KE, et al. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol, 2015, 26(3): 724-734.
9. 中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診治指南(2024 年版). 臨床肝膽病雜志, 2024, 40(12): 2371-2387.
10. Kanbay M, Ertuglu LA, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J, 2020, 13(6): 981-993.
11. Stefánsson BV, Brunelli SM, Cabrera C, et al. Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol, 2014, 9(12): 2124-2132.
12. Singh AT, Mc Causland FR. Osmolality and blood pressure stability during hemodialysis. Semin Dial, 2017, 30(6): 509-517.
13. Ma S, Xie Z, Zhang H, et al. Characterization of an artificial liver support system-related vasovagal reaction. Biomed Res Int, 2020, 2020: 6313480.
14. Chang TI, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol, 2011, 22(8): 1526-1533.
15. 劉尋, 王曉菲, 張婷, 等. 血液透析中低血壓臨床分析. 中國血液凈化, 2021, 20(1): 50-53.
16. Pinter J, Smyth B, Stuard S, et al. Effect of dialysate and plasma sodium on mortality in a global historical hemodialysis cohort. J Am Soc Nephrol, 2024, 35(2): 167-176.
17. Kuipers J, Verboom LM, Ipema KJR, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis. Am J Nephrol, 2019, 49(6): 497-506.
18. Arasnezhad M, Namazinia M, Mazlum SR, et al. The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study. BMC Nephrol, 2024, 25(1): 128.
19. Ettema EM, Kuipers J, van Faassen M, et al. Effect of plasma sodium concentration on blood pressure regulators during hemodialysis: a randomized crossover study. BMC Nephrol, 2018, 19(1): 214.
20. Praharaj DL, Anand AC. Clinical implications, evaluation, and management of hyponatremia in cirrhosis. J Clin Exp Hepatol, 2022, 12(2): 575-594.
21. 黃冬清, 羅珍玉, 黃小知, 等. 中青年體檢人群體質量指數與血糖和血脂及血壓相關性分析. 臨床醫藥實踐, 2022, 31(1): 55-58.
22. Li Y, Wright MD. Patient positioning during a hypotensive episode for adults undergoing hemodialysis: a review of clinical effectiveness and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2020.
23. 潘姚佳, 傅方琳, 韓正, 等. 肥胖類型與心血管代謝性共病的關系: 基于不同性別的中年居民. 中國全科醫學, 2025, 28(18): 2285-2293.
24. 孫偉航, 張驁丹, 李巍. 預后營養指數聯合磁共振表觀擴散系數在肝細胞癌肝動脈化療栓塞中的臨床應用價值. 中華醫學雜志, 2019, 99(33): 2581-2585.
25. 余玲, 呂麗敏, 陳亞丹. 臨床護士《血管活性藥物靜脈輸注護理》團體標準的執行情況. 中國衛生標準管理, 2023, 14(7): 7-12.

West China Medical Journal

Risk factor analysis for hypotension during double plasma molecular adsorption system therapy in hepatic failure patients

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