Early Systolic Blood Pressure Changes in Incident Hemodialysis Patients Are Associated with Mortality in the First Year

Sipahioğlu, Murat Hayri; Usvyat, Len; Liu, Li; Abbas, Samer R.; Raimann, Jochen G.; Rosales, Laura; Levin, Nathan W.; Kotanko, Peter

doi:10.1159/000342634

Cited by 10 publications

(13 citation statements)

References 38 publications

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“…In the aforementioned study of Renal Research Institute facilities, mean SBP declined sharply between the first and second weeks of treatment, from 150.5 to 147.7 mm Hg, before increasing during the rest of the first 12 weeks of treatment. 6 However, the aggregate pattern belies heterogeneity in SBP trends by initial SBP. In patients with severe hypertension (ie, initial SBP .…”

Section: Prevalence After Dialysis Initiationmentioning

confidence: 96%

Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use

Bakris

Burkart

Weinhandl

et al. 2016

American Journal of Kidney Diseases

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Hypertension is a cardinal feature of end-stage renal disease (ESRD). Hypertensive nephropathy is the primary cause of ESRD for nearly 30% of patients, and the prevalence of hypertension is >85% in new patients with ESRD. In contemporary hemodialysis (HD) patients, mean predialysis systolic blood pressure (SBP) is nearly 150mmHg, and about 70%, 50%, and 40% use β-blockers, calcium channel blockers, and renin-angiotensin system inhibitors, respectively. Predialysis SBP generally exhibits a U-shaped association with mortality risk. Interdialytic ambulatory SBP is more strongly associated with risk. Hypertension is multifactorial; key causes include persistent hypervolemia and elevated peripheral resistance. With 3 HD sessions per week, blood pressure (BP) climbs during the interdialytic interval, in step with interdialytic weight gain, particularly among elderly patients and those with higher dry weight. Elevated peripheral resistance can be attributed to inappropriate activation of the sympathetic nervous system due to higher plasma norepinephrine concentrations. Multiple randomized clinical trials show that intensive HD reduces BP and the need for oral medications indicated for hypertension. In the first 2 months of the Frequent Hemodialysis Network trial, the short daily schedule reduced predialysis SBP by 7.7mmHg, whereas the nocturnal schedule reduced predialysis SBP by 7.3mmHg, both relative to 3 sessions per week. Improvements were sustained after 12 months. Both schedules reduced antihypertensive medication use relative to 3 sessions per week. In FREEDOM (Following Rehabilitation, Economics, and Everyday-Dialysis Outcome Measurements), a prospective cohort study of short daily HD, the mean number of prescribed antihypertensive agents decreased from 1.7 to 1.0 in 1 year, whereas the percentage of patients not prescribed antihypertensive agents increased from 21% to 47%. Nocturnal HD appears to markedly reduce total peripheral resistance and plasma norepinephrine and restore endothelium-dependent vasodilation. In conclusion, intensive HD reduces BP and the need for antihypertensive medications.

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Section: Prevalence After Dialysis Initiationmentioning

confidence: 96%

Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use

Bakris

Burkart

Weinhandl

et al. 2016

American Journal of Kidney Diseases

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“…In contrast, a study comprising 3446 incident dialysis patients of a US provider [ 32 ] showed an initial decrease in systolic BP within the first week after the start of dialysis, followed by a steady increase and a plateau phase after 12 weeks. No major differences in mean pre-dialytic systolic BP levels in the overall cohort were observed between the start of dialysis and a 1-year follow-up period [ 32 ]. Also in this study, low pre-dialytic BP (defined as systolic BP <120 mmHg) at the start of dialysis was associated with increased early (6–12 weeks) mortality.…”

Section: Cardiovascular Parametersmentioning

confidence: 99%

The first year on haemodialysis: a critical transition

et al. 2015

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The first year following the start of haemodialysis (HD) is associated with increased mortality, especially during the first 90–120 days after the start of dialysis. Whereas the start of dialysis has important effects on the internal environment of the patient, there are relatively few studies assessing changes in phenotype and underlying mechanisms during the transition period following pre-dialysis to dialysis care, although more insight into these parameters is of importance in unravelling the causes of this increased early mortality. In this review, changes in cardiovascular, nutritional and inflammatory parameters during the first year of HD, as well as changes in physical and functional performance are discussed. Treatment-related factors that might contribute to these changes include vascular access and pre-dialysis care, dialysate prescription and the insufficient correction of the internal environment by current dialysis techniques. Patient-related factors include the ongoing loss of residual renal function and the progression of comorbid disease. Identifying phenotypic changes and targeting risk patterns might improve outcome during the transition period. Given the scarcity of data on this subject, more research is needed.

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“…It has been shown that trajectories of common clinical and laboratory parameters following the start of dialysis were related to increased mortality. This was true even for downward trends in serum albumin and body weight, and both upward and downward trends of predialytic systolic BP and body temperature [56][57][58][59][60] (Fig. 3).…”

Section: Predicting the Future: Forward Trajectoriesmentioning

confidence: 84%

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

et al. 2018

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Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1–2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.

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Early Systolic Blood Pressure Changes in Incident Hemodialysis Patients Are Associated with Mortality in the First Year

Cited by 10 publications

References 38 publications

Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use

Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use

The first year on haemodialysis: a critical transition

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

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