Intra-dialytic blood pressure variability is a greater predictor of cardiovascular events in hemodialysis patients

Liu, Qixing; Wang, Wei; Wu, Xin; Lv, Jian; Cai, Shiming; Li, Yuehong

doi:10.1186/s12882-023-03162-w

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…The risk of cardiac and all‐cause mortality was significantly higher in patients with high home SBPV, this result was similar to those of previous studies, 15 while the present study found there is no U‐shaped curve relationship between home SBPV and adverse outcomes. Previous researchers have demonstrated that both short‐term and long‐term SBPV are risk factors for poor outcomes in patients with MHD, whereas conclusions about the effect of DBPV on patient survival outcomes are not entirely consistent 16–19 …”

Section: Discussionmentioning

confidence: 99%

Interdialytic home systolic blood pressure variability increases all‐cause mortality in hemodialysis patients

Dong,

Tian,

et al. 2024

Clinical Cardiology

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BackgroundThe association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown.HypothesisWe proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all‐cause mortality among individuals undergoing MHD.MethodsA total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all‐cause death. Kaplan–Meier analysis was used to assess the relationship between long‐term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis.ResultsThe risk of cardiac death and all‐cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all‐cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates.ConclusionsThe findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.

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Section: Discussionmentioning

confidence: 99%

Interdialytic home systolic blood pressure variability increases all‐cause mortality in hemodialysis patients

Dong,

Tian,

et al. 2024

Clinical Cardiology

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“…Several studies had shown the effect of high BPV within CKD-HD patients towards poor cardiovascular outcome, higher cardiovascular mortality, and higher all-cause mortality. This should raise concern particularly considering the high proportion of subjects with frailty with mean age of 56.2 ± 9.4 years, which have not even pass the geriatric age threshold [6], [23].…”

Section: Discussionmentioning

confidence: 99%

The Association between Frailty Status and Blood Pressure Variability in Chronic Kidney Disease Patients Undergoing Hemodialysis

Wardani,

Lydia,

Harimurti

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: The high mortality rate of patients with chronic kidney disease undergoing hemodialysis (CKD-HD) is influenced by the high number of cardiovascular-induced death and blood pressure variability (BPV). AIM: The aim of this study is to understand the association between frailty status and intradialytic BPV. METHODS: This is a cross-sectional study examining patients with CKD who underwent hemodialysis (HD) at Dr. Cipto Mangunkusumo National General Hospital from August to September 2022. BPV was calculated using the average real variability method and frailty status was assessed based on Frailty Index 40 Item. The association between frailty and systolic BPV was analyzed using the Chi-Square test, followed by logistic regression analysis to exclude the influence of the confounding variable. RESULTS: Out of 88 subjects recruited, 28.4% (95% CI: 18.98–37.82) were considered frail, 55.7% (95% CI: 45.32–66.08) were pre-frail, and 15.9% (95% CI: 8.26–23.54) were robust. The mean intradialytic BPV was 10.11 (8.60–13.35). It was found that the trend increased along with the rising frailty status, and the mean difference of intradialytic systolic BPV based on the results of Kruskal–Wallis testing had statistical significance. The result of the multivariate analysis revealed an increase in BPV prevalence in patients with pre-frailty (adjusted PR = 1.606, 95% CI: 0.681–3.787) and frailty (adjusted PR = 1.886 (95% CI: 0.783–4.545). CONCLUSION: Statistically, there is no association between frailty status and intradialytic BPV. However, clinically, a dose-response association was observed, indicating that the higher the frailty status, the higher the prevalence ratio for the occurrence of high BPV.

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Characteristics and Influencing Factors of Intra-Dialysis Blood Pressure Variability in Hemodialysis Patients: A Retrospective Study

Xu,

Wang,

Feng

et al. 2024

IJGM

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Objective To investigate the correlation between background factors and blood pressure variability (BPV), and the prognostic value of intra-dialytic BPV metrics for cardiovascular death and all-cause mortality in hemodialysis (HD) patients. Methods A retrospective study of 264 hD patients was followed up for 36 months. The intra-dialytic BP during the 3-month period for each patient was used to calculate BPV metrics, including standard deviation (SD), coefficient of variation (CV), average real variability (ARV), blood pressure change (ΔBP), and percent change in blood pressure (ΔBP/pre-BP). The primary outcomes were CVD death and all-cause mortality. Results Age, body mass index (BMI), predialysis blood pressure, inter-dialytic weight gain rate (IDWG%), α- blockers, and cholesterol levels were positively correlated with intra-dialytic BPV. Hemoglobin and albumin are negatively associated with intra-dialytic BPV. In Cox regression analysis, SBP-ARV, ΔSBP, and ΔSBP/pre-SBP were independent risk factors for CVD death (HR: 1.087, 95% CI: 1.001–1.181, p = 0.047; HR: 1.072, 95% CI: 1.016–1.131, p = 0.011; HR: 1.107, 95% CI: 1.011–1.211, p = 0.028). SBP-ARV showed the largest AUC of 0.593 (p = 0.022) in predicting all-cause death. SBP-ARV, ΔSBP, and ΔSBP/pre-SBP showed relatively large area (AUC = 0.631, 0.639, and 0.620; p = 0.007, 0.004, and 0.013 respectively) in predicting CVD death. Conclusion Age, BMI, IDWG%, predialysis blood pressure, albumin, hemoglobin, α- blockers, and total cholesterol were significantly correlated with intra-dialytic BPV. SBP-ARV, ΔSBP, and ΔSBP/pre-SBP were independent risk factors for CVD mortality, and there were no differences in prognostic value among various BPV metrics.

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Intra-dialytic blood pressure variability is a greater predictor of cardiovascular events in hemodialysis patients

Cited by 3 publications

References 27 publications

Interdialytic home systolic blood pressure variability increases all‐cause mortality in hemodialysis patients

Interdialytic home systolic blood pressure variability increases all‐cause mortality in hemodialysis patients

The Association between Frailty Status and Blood Pressure Variability in Chronic Kidney Disease Patients Undergoing Hemodialysis

Characteristics and Influencing Factors of Intra-Dialysis Blood Pressure Variability in Hemodialysis Patients: A Retrospective Study

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