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

Abstract

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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; <i>p</i> < 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10–1.22; <i>p</i> < 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; <i>p</i> = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06–1.22; <i>p</i> < 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (<i>p</i> = 0.01) and cardiovascular (<i>p</i> = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01–1.17; <i>p</i> = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52–1.42; <i>p</i> = 0.56). <b><i>Conclusions:</i></b> 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).

Characteristics of Month-by-Month Blood Pressure Variability in Patients on Hemodialysis

“…Several cohort studies have reported that VVBPV, independent of absolute BP, may be a predictor of patient prognosis [34]. To the best of our knowledge, this study is the first to assess the association of MMBPV (including SD, CV, and VIM) and seasonal variability, as indices of long-term BP variability, with cardiovascular deaths.…”

Extremity Joint Range of Motion Exercise on Intradialytic Blood Pressure Control in Hemodialysis Patients

“…Cardiovascular disease is associated with worse short-and long-term survival outcomes in patients with chronic renal failure and lowering blood pressure may reduce cardiovascular risk, but changes in blood pressure were not significant due to low to moderate exercise intensity as assessed using the Borg score and Short duration and low to moderate intensity exercise training is not enough to reduce blood pressure (Cheng et al, 2020). Blood pressure during hemodialysis changes due to high potassium levels and low sodium levels which can reduce blood pressure (Nuari & Widayati, 2017) .The mechanism of changes in blood pressure can be influenced by behavioral, emotional and cardiovascular physiological factors, while arterial stiffness contributes to short and long term blood pressure, the above risk factors cause patients to experience poor blood volume fluctuations during dialysis, but diastolic blood pressure is not a predictor of cardiovascular death (Zhao et al, 2021) The predialysis blood pressure target is 90 mmHg and post diastolic 80 mmHg (Rocco et al, 2015) . The blood pressure of dialysis patients varies from pre-dialysis to post-dialysis and from day 1 to the next (Georgianos & Agarwal, 2017) .…”

Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review

“…Potential benefits of telemedicine (including telemonitoring) for the management of hypertension have been reported across several studies [55,89,90] and include the ability to provide care where face-to-face consultation is not possible, the possibility to reach underserved areas and their population, patient empowerment through self-management and participation, improved patient-caregiver relationship, and assessment of health data in real-time, accelerated delivery of best practice, reduced patient travel time, improved quality of care and the health outcomes, and cost-effectiveness. As hypertension is ubiquitous across all stages of CKD, HBPT can be leveraged to improve BP control and adherence and reduce adverse CV outcomes, including stroke, myocardial infarction, heart failure, and sudden death.…”