The association of long-term blood pressure variability with hemodialysis access thrombosis

Abstract

BackgroundBlood pressure variability (BPV) is an important risk factor for cardiovascular events in hemodialysis patients. We sought to determine the impact of BPV on hemodialysis access thrombosis.MethodsWe enrolled 1,011 prevalent hemodialysis patients from 12 hemodialysis centers since January 2018 and followed them until December 2020. Predialysis blood pressure (BP) was assessed at 12-week intervals. The coefficient of variation derived from 36 consecutive BP measurements was used as the metric for variability. The primary outcome was incident hemodialysis access thrombosis. Linear regression models were used to assess factors associated with BPV at baseline. Kaplan-Meier curves of the time until vascular access events were drawn and log-rank tests were calculated. Cox proportional hazards models were performed to assess the association of BPV with incident vascular access events.ResultsThe average coefficient of variance for systolic BPV was 10.9%. BPV was associated with age, body mass index, mean BP, diabetes, coronary and peripheral artery disease, history of access dysfunction, graft access, intradialytic hypotension, and use of antihypertensive medications. There were 194 access thrombosis events and 451 access stenosis events during a median follow-up period of 30 months. After adjustment of potential confounding factors, BPV was associated with increased risk of access thrombosis [hazard ratio = 1.27, 95% confidence interval (CI), 1.18–1.44, per 1 standard deviation increase in BPV]. The patients in the highest BPV quartile had 2.45 times the risk of thrombosis (CI, 1.62–3.70). The association was independent of average BP, intradialytic hypotension, and comorbidities. Similar trends of association were found in the subgroups analyzed. Comparative analysis using a time-varying variable model and different metrics of BPV showed consistent results.ConclusionOur findings underscored the impact of BP fluctuation on vascular access thrombosis.

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

“…Although the metabolic substances, vasoactive mediators, and water accumulated during hemodialysis are removed, severe changes in hemodynamics and internal environment in a short time cause significant fluctuations in blood pressure. Consistent with previous studies, we found higher BPV in older patients with diabetes 30 . In addition, we found that outcomes derived from bioelectrical impedance revealed a correlation between increased visceral fat content and body fat percentage, diminished muscle content and phase angle, and heightened BPV.…”

“…Consistent with previous studies, we found higher BPV in older patients with diabetes. 30 In addition, we found that outcomes derived from bioelectrical impedance revealed a correlation between increased visceral fat content and body fat percentage, diminished muscle content and phase angle, and heightened BPV.…”

Variability: The Hallmark of Blood Pressure Measurement – Types, Assessment and Prognostic Significance

“…Hsieh MY et al, in their study of 1011 patients on regular dialysis, found BPV was associated with an increased risk of access thrombosis [HR= 1.27, 95% CI, 1.18-1.44, /SD increase in BPV]. 40 The risk in patients was 2.45 times in the highest BPV quartile.…”

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

“…Excessive fluctuation of BP during dialysis may contribute to access thrombosis, further highlighting the importance of accurately assessing volume status to minimize complications. 75 Therefore, there is a need for further research to identify reliable and easily accessible methods for assessing ideal volume status in hemodialysis patients to improve clinical outcomes.…”