Association of Age and BP Variability with Long-term Mortality in Hemodialysis Patients

Kim, Ha Yeon; Kang, Yong Un; Kim, Chang Seong; Choi, Joon Seok; Bae, Eun Hui; Kwon, Seong Soon; Kim, Soo Wan

doi:10.1159/000355765

Cited by 9 publications

(12 citation statements)

References 24 publications

(26 reference statements)

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“…Besides, researchers have found out many other factors associated with BPV, including age, dialytic sessions, and dialytic frequency [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients

Liao¹,

Li²,

Xiong³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Blood pressure variability (BPV) is a novel cardiovascular risk factor for the population undergoing hemodialysis (HD). Methods: We conducted a retrospective cohort study of 526 HD patients. Four short-term peridialysis BPV metrics were analyzed: systolic blood pressure (SBP) change, SBP coefficient of variation (CV), SBP intradialytic average real variability (ARV), and absolute SBP residual. Multi variate analysis with Cox regression models were used to account for the potential confounders. Results: Short-term BPV is found to be affected by age, pre-dialysis SBP, antihypertensive drugs, dialysis time, and vascular access. Calcium-channel blockers (CCBs) were found to be associated with lower BPV than those on non-CCB therapy or no antihypertensive drugs. Patients dialyzed in the morning had a greater absolute SBP change than those dialyzed in the afternoon or evening. Patients using fistulas had a lower BPV than catheters. Higher BPV metrics including SBP CV (unadjusted hazard ratio [HR]: 1.37, 95% confidence interval [CI] 1.14-1.66, p=0.001), SBP intradialytic ARV (unadjusted HR: 1.46, 95% CI: 1.20-1.77, p< 0.001), and SBP residual (unadjusted HR: 1.47, 95% CI: 1.21-1.79, p< 0.001) were associated with a greater risk of cardiovascular events. After complete multivariate adjustment for other potential confounders, the HR remained statistically significant for SBP intradialytic ARV (HR 1.31, 95% CI: 1.04-1.66, p=0.024). Conclusion: Peridialytic BPV may be a potential target for improved blood pressure (BP) management in HD patients. Each short-term BPV metric has different advantages and disadvantages and should be applied according to the clinical context and purpose.

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“…Besides, researchers have found out many other factors associated with BPV, including age, dialytic sessions, and dialytic frequency [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients

Liao¹,

Li²,

Xiong³

et al. 2018

Kidney Blood Press Res

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“…Thus, a total of 14 studies were included in this systematic review and meta-analysis (Fig. 1) [8][9][10][11][15][16][17][18][19][20][21][22][23][24].…”

Section: Resultsmentioning

confidence: 99%

Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Zhao

Yang

et al. 2020

Kidney Dis

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Background: The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population. Methods: Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included. Results: A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07–1.19; p < 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10–1.22; p < 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05–1.17; p = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06–1.22; p < 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (p = 0.01) and cardiovascular (p = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01–1.17; p = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52–1.42; p = 0.56). Conclusions: This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).

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“…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].…”

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

“…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]. 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].…”

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

“…Studies have found an association between the mean BP and outcomes in patients on HD [15][16][17]. Over the last decade, more studies have explored the impact of BPV on the prognosis of HD patients, with inconsistent results [18][19][20][21][22][23][24][25]. Therefore, we conducted a systematic review and meta-analysis to assess the prognostic significance of BPV on cardiovascular and all-cause mortality and cardiovascular events in ESRD patients on dialysis.…”

Section: Introductionmentioning

confidence: 99%

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

Xue

Dai

et al. 2020

Kidney Blood Press Res

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Objective: Previous studies have suggested that blood pressure variability (BPV) is associated with an increased risk of mortality and cardiovascular events in patients on dialysis. However, the results are inconsistent. A comprehensive literature review was conducted to analyze the association between BPV and outcomes in patients on dialysis. Methods: Articles in Embase, Medline, and Web of Science from the date of inception through January 1, 2020, were identified. The outcomes were all-cause and cardiovascular mortality and cardiovascular events. The risk of bias was assessed using the Newcastle-Ottawa scale tool. Random effects models were used to pool the overall effect sizes. Two reviewers extracted the data independently. Meta-regression and subgroup analyses were performed to explore potential heterogeneity. Results: Fifteen eligible studies were included, and all enrolled hemodialysis recipients only. The overall risk of bias for the included studies was low. A 1-SD increase in systolic BPV was associated with higher risks of all-cause mortality (HR = 1.18; 95% CI 1.11–1.26, I2 = 53.8%), cardiovascular mortality (HR = 1.23; 95% CI 1.10–1.37, I2 = 57.2%), and cardiovascular events (HR = 1.27; 95% CI 1.07–1.51, I2 = 69.3%). Likewise, a 1-SD increase in diastolic BPV was associated with higher HR for all-cause and cardiovascular mortality (HR = 1.14; 95% CI 1.05–1.23, I2 = 0.0%, and HR = 1.14; 95% CI 0.94–1.38, I2 = 0.0%, respectively). Conclusions: A greater BPV is associated with higher risks of cardiovascular and mortality outcomes in patients on hemodialysis. Further research is required to determine whether BPV may be useful either as a marker enabling individualized treatment of cardiovascular risk or as a treatment target in its own right.

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Association of Age and BP Variability with Long-term Mortality in Hemodialysis Patients

Cited by 9 publications

References 24 publications

Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients

Association of Peridialysis Blood Pressure and Its Variability with Cardiovascular Events in Hemodialysis Patients

Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

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

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