Factors Associated With Intradialytic Systolic Blood Pressure Variability

Flythe, Jennifer E.; Kunaparaju, Srikanth; Dinesh, Kumar P.; Cape, Kathryn; Feldman, Harold I.; Brunelli, Steven M.

doi:10.1053/j.ajkd.2011.11.026

Cited by 68 publications

(62 citation statements)

References 31 publications

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“…By necessitating more rapid fluid removal in a compressed timeframe, shorter dialysis sessions expose patients to greater fluid shifts with attendant myocardial stunning and ischemia (15), intradialytic hypotension, hemodynamic destabilization (16), and resultant interruptions of end-organ perfusion. The cumulative consequences of these cardiac stresses have been linked to maladaptive changes in left ventricular geometry such as hypertrophy and fibrosis with derivative heart failure and conduction system abnormalities (15,(17)(18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Disentangling the Ultrafiltration Rate–Mortality Association

Flythe

Curhan

Brunelli

2013

Clinical Journal of the American Society of Nephrology

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103

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SummaryBackground and objectives Rapid ultrafiltration rate is associated with increased mortality among hemodialysis patients. Ultrafiltration rates are determined by interdialytic weight gain and session length. Although both interdialytic weight gain and session length have been linked to mortality, the relationship of each to mortality, independent of the other, is not adequately defined. This study was designed to evaluate whether shorter session length independent of weight gain and larger weight gain independent of session length are associated with increased mortality.Design, setting, participants, & measurements Data were taken from a national cohort of 14,643 prevalent, thriceweekly, in-center hemodialysis patients dialyzing from 2005 to 2009 (median survival time, 25 months) at a single dialysis organization. Patients with adequate urea clearance and delivered dialysis session $240 and ,240 minutes were pair-matched on interdialytic weight gain (n=1794), and patients with weight gain #3 and .3 kg were pair-matched on session length (n=2114); mortality associations were estimated separately.Results Compared with delivered session length $240, session length ,240 minutes was associated with increased all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.32 [1.03 to 1.69]). Compared with weight gain #3, weight gain .3 kg was associated with increased mortality (1.29 [1.01 to 1.65]). The associations were consistent across strata of age, sex, weight, and weight gain and session length. Secondary analyses demonstrated dose-response relationships between both and mortality.Conclusions Among patients with adequate urea clearance, shorter dialysis session length and greater interdialytic weight gain are associated with increased mortality; thus, both are viable targets for directed intervention.

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Section: Discussionmentioning

confidence: 99%

Disentangling the Ultrafiltration Rate–Mortality Association

Flythe

Curhan

Brunelli

2013

Clinical Journal of the American Society of Nephrology

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103

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“…10 In a prior study, the same authors identified older age, shorter dialysis vintage, and greater ultrafiltration (rate and volume) as associated with greater intradialytic BPV. 11 Contrary to findings in the general population, neither Chang et al nor Flythe et al found antihypertensive agents to play a significant role in visit-to-visit or intradialytic BPV-outcome associations among HD patients. 9,11 In this issue of JASN, Shafi et al present further observational data linking visit-to-visit BPV and all-cause and cardiovascular morbidity and mortality.…”

mentioning

confidence: 82%

“…11 Contrary to findings in the general population, neither Chang et al nor Flythe et al found antihypertensive agents to play a significant role in visit-to-visit or intradialytic BPV-outcome associations among HD patients. 9,11 In this issue of JASN, Shafi et al present further observational data linking visit-to-visit BPV and all-cause and cardiovascular morbidity and mortality. 12 In a contemporary cohort of 11,291 incident HD patients from a single dialysis organization, the authors demonstrate an association between greater predialysis systolic BPVand higher body mass index, higher calcium-phosphate product levels, and lower hemoglobin concentrations.…”

mentioning

confidence: 82%

“…The issue of intradialytic BPV is of particular interest because Flythe et al demonstrated an association between greater intradialytic BPVand greater ultrafiltration rate and volume. 11 On the other hand, Shafi et al found an association between lesser pre-HD BPVand greater ultrafiltration rate and volume. Shafi and colleagues' finding might reflect the practice of stopping or reducing J Am Soc Nephrol 25: 647-655, 2014 Editorials ultrafiltration in hemodynamically unstable patients; this hypothesis is supported by the fact that patients in the highest BPV quartile were less likely to achieve target weight than patients in lower BPV quartiles.…”

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confidence: 98%

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Blood Pressure Variability and Dialysis

Flythe

Brunelli

2014

Journal of the American Society of Nephrology

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“…10 It is well known that healthy subjects can tolerate a decline in circulating blood volume up to 20% before hypotension occurs, but in patients on chronic hemodialysis hypotension may occur with a significant smaller decline in blood volume. 6 Recently, Flythe et al 11 have demonstrated that systolic blood pressure variability in patients on chronic hemodialysis is associated with greater dialytic fluid removal and rate as well as with older age and dialytic age (DA).…”

Section: Introductionmentioning

confidence: 99%

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Bossola¹,

Laudisio²,

Antocicco³

et al. 2013

Renal Failure

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Objective: Intradialytic hypotension (IDH) is common in patients on chronic hemodialysis, but knowledge on determinants is still unclear. The present study aims at evaluating the association between IDH and dialytic age (DA) in patients on chronic hemodialysis. Methods: Between January 2012 and January 2013, 82 patients on chronic hemodialysis for at least 1 year were screened for inclusion in the present study. Of these, 14 were excluded because of advanced heart failure (n.9), history of alcohol/substance abuse (n.1), diagnosis of dementia (n.2), actual instability of clinical conditions requiring hospitalization (n.2). IDH was defined as a decrease in systolic blood pressure !20 mmHg or a decrease in mean arterial pressure (MAP) by 10 mmHg associated with clinical events and need for nursing interventions. The number of IDH episodes in 10 consecutive hemodialysis sessions was recorded for each patient. Linear and logistic regressions were adopted to assess the adjusted association between IDH and DA. Conclusion: DA is associated with an increased probability of IDH and with increased number of IHD events. Studies are needed to understand the underlying factors of such an association.

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Factors Associated With Intradialytic Systolic Blood Pressure Variability

Cited by 68 publications

References 31 publications

Disentangling the Ultrafiltration Rate–Mortality Association

Disentangling the Ultrafiltration Rate–Mortality Association

Blood Pressure Variability and Dialysis

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

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