Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients

Abstract

The relationship between blood pressure (BP) and clinical outcomes among hemodialysis patients is complex and incompletely understood. This study sought to assess the relationship between blood pressure changes with hemodialysis and clinical outcomes during a 6-month period. This study is a secondary analysis of the Crit-Line Intradialytic Monitoring Benefit Study, a randomized trial of 443 hemodialysis subjects, designed to determine whether blood volume monitoring reduced hospitalization. Logistic regression was used to estimate the association between BP changes with hemodialysis (Deltasystolic blood pressure=postdialysis-predialysis systoic BP (SBP) and the primary outcome of non-access-related hospitalization and death. Subjects whose systolic blood pressure fell with dialysis were younger, took fewer blood pressure medications, had higher serum creatinine, and higher dry weights. After controlling for baseline characteristics, lab variables, and treatment group, subjects whose SBP remained unchanged with hemodialysis (N=150, DeltaSBP -10 to 10 mm Hg) or whose SBP rose with hemodialysis (N=58, DeltaSBP > or =10 mm Hg) had a higher odds of hospitalization or death compared to subjects whose SBP fell with hemodialysis (N=230, DeltaSBP < or =-10 mm Hg) (odds ratio: 1.85, confidence interval: 1.15-2.98; and odds ratio: 2.17, confidence interval: 1.13-4.15). Subjects whose systolic blood pressure fell with hemodialysis had a significantly decreased risk of hospitalization or death at 6 months, suggesting that hemodynamic responses to dialysis are associated with short-term outcomes among a group of prevalent hemodialysis subjects. Further research should attempt to elucidate the mechanisms behind these findings.

Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records

“…However, we note that hemodynamic factors were still important to these longer-term models. Previous work has shown BP variability to be an important correlate of cardiovascular outcomes (28)(29)(30). Overall, these results suggest that the EHR data are not only suitable for near-term prediction but in fact, optimal for it.…”

Modeled Urea Distribution Volume and Mortality in the HEMO Study

“…Also, higher V m / V ant ratios were associated with smaller falls in SBP during dialysis, whether calculated using the postdialysis SBP or the lowest measured intradialytic BP. These results are consistent with data from Inrig et al (21,22), who found that the highest survival in patients with the greatest intradialytic fall in BP, whereas patients in whom BP did not fall or in whom BP increased, mortality risk was increased. It is tempting to speculate that the increase in V m /V ant and the lower decrement in intradialytic BP in patients in whom V m /V ant was increased were both related to fluid overload.…”

Intradialytic Hypertension and its Association with Endothelial Cell Dysfunction

“…We have previously identified intradialytic hypertension to be associated with more than a two-fold increase in hazard of hospitalization and death, as well as with higher 2-year mortality (2)(3)(4). In this study, we identified a novel association between the presence of intradialytic hypertension and significant impairment in markers of in vivo endothelial cell function.…”

“…Although it has been recognized for decades, recently our laboratory has identified intradialytic hypertension as an independent predictor of adverse clinical outcomes including nonaccess related hospitalization and mortality (2)(3)(4). Despite its clinical significance, little is known about the pathophysiologic mechanisms underlying intradialytic hypertension.…”