Background Blood pressure is known to fluctuate widely during hemodialysis; however, little is known about the association between intradialytic blood pressure variability and outcomes. Study Design Retrospective observational cohort Setting & Participants A random sample of 6,393 adult, thrice-weekly, in-center, maintenance hemodialysis patients dialyzing at 1,026 dialysis units within a single large dialysis organization. Predictor Intradialytic systolic blood pressure (SBP) variability. This was calculated using a mixed linear effects model. Peri-dialytic SBP phenomena were defined as starting SBP (regression intercept), systematic change in SBP over the course of dialysis (2 regression slopes), and random intradialytic SBP variability (absolute regression residual). Outcomes All-cause and cardiovascular mortality. Measurements SBPs (n=631,922) measured during hemodialysis treatments (n=78,961) over the first 30 days in study. Outcome data were obtained from the dialysis unit electronic medical record and were considered beginning on day 31. Results High (ie, greater than the median) versus low SBP variability was associated with a greater risk of all-cause mortality (adjusted HR, 1.26; 95% CI, 1.08–1.47). The association between high SBP variability and cardiovascular mortality was even more potent (adjusted HR, 1.32; 85% CI, 1.01–1.72). A dose response trend was observed across quartiles of SBP variability for both all-cause (p=0.001) and cardiovascular (p=0.04) mortality. Limitations Inclusion of subjects from a single large dialysis organization, over-representation of African Americans and patients with diabetes and heart failure, and lack of standardized SBP measurements. Conclusions Greater intradialytic SBP variability is independently associated with increased all-cause and cardiovascular mortality. Further prospective studies are needed to confirm findings and identify means of reducing SBP variability to facilitate randomized study.

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<b><i>Introduction:</i></b> Kidney biopsy findings in patients with human immunodeficiency virus (HIV) are diverse, and optimal therapy for the various immune complex diseases in the setting of HIV is unknown. <b><i>Case Presentation:</i></b> A man with well-controlled HIV developed nephrotic range proteinuria, and kidney biopsy revealed lupus-like glomerulonephritis with a predominantly membranous pattern of injury. He opted for conservative therapy and experienced spontaneous and sustained remission. Subsequent testing revealed neural epidermal growth factor-like 1 (NELL1)-positive glomerular immune deposits. NELL1-positive glomerular immune deposits were identified in a total of 2 of 5 tested HIV-associated membranous nephropathy (MN), which were morphologically dissimilar and one of which weakly co-expressed phospholipase A2 receptor (PLA2R). <b><i>Discussion:</i></b> This case suggests potentially different outcomes in patients with immune complex diseases in the setting of HIV based on disease etiology and histopathology. HIV-associated MN is occasionally NELL1-positive.