Variability in Predialysis Systolic Blood Pressure and Long-Term Outcomes in Hemodialysis Patients

Abstract

Background/Aims: While systolic blood pressure variability (SBPV) is an independent risk factor for mortality in the general population, its association with outcomes in hemodialysis patients has been less well-investigated. Methods: In this retrospective study, we enrolled 99 eligible HD patients from 2006 to 2016. Predialysis blood pressure measurements obtained over 1-year period were used to determine each patient’s BPV. The standard deviation (SD), the coefficient of variation (CV) and the variation independent of the mean (VIM) were used as metrics of BPV. Results: During a median follow-up period of 68 months, 52 patients died, and cardiovascular disease (31.3%) was the primary cause of death in these patients. After adjusting for covariates, the hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.80 (95% confidence interval (CI) 1.11-2.92) and 1.71 (95% CI 1.01-2.90), respectively, for a one percent increase in CV. Variability in the volume removed per session and predialysis serum albumin and calcium levels were identified as factors associated with BPV. Conclusion: In this study, we demonstrate that greater variability in predialysis SBP is associated with long-term mortality in hemodialysis patients. Controlling volume variation, avoiding hypoalbuminemia and reducing blood calcium levels might reduce SBP variability and thereby improve prognoses in these patients.

The Association between Long- and Intra-Dialytic Blood Pressure Variability with All-Cause Mortality in Hemodialysis Patients

“…The association between long-term BPV and clinical outcomes in HD patients has been studied in many previous studies [5,16,22,23], but the advantage of long-term BPV over intra-dialytic BPV in predicting mortality was reported for the first time. Only a few studies have compared the prognostic ability of longterm BPV with short-term BPV in non-HD patients, and have reached conflicting conclusions.…”

“…Both long-term and short-term BPV have been shown to be predictors for mortality in HD patients [5,[14][15][16]. Many earlier studies on BPV used robust metrics like systolic blood pressure (SBP) SD and co-efficient of variation (CV) [17] for drawing conclusions while more effective novel metrics like average real variability (ARV) and SBP residual were used in recent studies [14,18].…”

“…Shafi et al [15] and Flythe et al [14] analyzed long-term BPV and intra-dialytic BPV using mixed effect model to arrive at a residual BPV metric that considers the physiologic BP fluctuations during dialysis to predict outcomes. Other BPV metrics including SD, CV, and ARV were also studied and showed predictive capability for mortality in HD patients [5,16].…”

Blood Pressure Variability and Outcomes in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis

“…One study presented overlapping data using the same datasets and was excluded [19]. Ultimately, the review included 15 eligible studies [18,[20][21][22][23][24][25][35][36][37][38][39][40][41][42]. Results from 2 studies did not provide sufficient data for the pooled analysis [22,42].…”

“…Results from 2 studies did not provide sufficient data for the pooled analysis [22,42]. Thus a total of 13 studies were included in the meta-analyses [18,20,21,[23][24][25][35][36][37][38][39][40][41].…”