Pre-Dialysis Systolic Blood Pressure-Variability Is Independently Associated with All-Cause Mortality in Incident Haemodialysis Patients

Selvarajah, Viknesh; Pasea, Laura; Ojha, Sanjay Kumar; Wilkinson, Ian B.; Tomlinson, Laurie

doi:10.1371/journal.pone.0086514

Cited by 32 publications

(31 citation statements)

References 21 publications

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“…These remain, however, less well-investigated in hemodialysis patients. SD, CV and VIM were recognized as the most common BPV metrics [3, 4, 12, 14]，but no evidence supporting which one is better. The ROC curves showed no difference among the three metrics in predicting the mortality (data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…Measurements were obtained immediately before, after, and during each dialysis session from January 1, 2006 to December 31, 2006. Raw BPs were transformed into the following 3 candidate BPV metrics, which are widely used in BPV studies [3, 4, 12, 14]: the standard deviation (SD), the coefficient of variation (CV), and the variation independent of the mean (VIM). VIM is a transformation of the standard deviation that is uncorrelated with mean BP and is calculated as follows:…”

Section: Methodsmentioning

confidence: 99%

“…A few previous studies found that predialysis BPV was associated with mortality in HD patients. However, most of these studies [11, 12] used blood pressure measurements obtained over 3 months to calculate BPV which didn’t consider seasonal changes in BP, and generally lacked long-term follow-up [11, 13]. We therefore sought to investigate the association between predialysis BPV measurements obtained during a full year and all-cause and cardiovascular mortality over a 10-year follow-up period in a cohort study of HD patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Wang

Qin

Fan

et al. 2018

Kidney Blood Press Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wang

Qin

Fan

et al. 2018

Kidney Blood Press Res

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“…It has been demonstrated that visit-to-visit BPV is extremely high in HD patients than non-HD populations and is a strong predictor for cardiovascular events [45]. Pre-dialysis systolic BPV is also associated with cardiovascular and all-cause mortality [46][47][48]. Not only pre-dialysis BPV but also intra-and post-dialysis BPV are related to adverse outcomes.…”

Section: Considerations For Blood Pressure Variability (Bpv)mentioning

confidence: 99%

Management of hypertension for patients undergoing dialysis therapy

Taniyama

2016

Ren Replace Ther

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Hypertension is very prevalent among patients undergoing dialysis therapy: hemodialysis (HD) and peritoneal dialysis (PD). Although it is recognized as a great risk of cardiovascular mortality for these populations, how to regulate blood pressure (BP) is poorly understood. For HD patients, we should pay much attention to methods of measuring BP. Outof-center BP levels and BP variability should be evaluated by ambulatory BP monitoring and home BP measurement because they are closely associated with cardiovascular mortality. Although target BP levels are not clear, several clinical guidelines suggest <140/90 mmHg. However, it must be determined for each individual patient with careful considerations about comorbidities. Based on the underling pathophysiology of hypertension in patients on dialysis, maintaining an appropriate volume of body fluid by dietary salt restriction and optimization of dry weigh should be considered as a first line therapy. Inhibitors for renin-angiotensin system may be suitable to reduce BP and mortality for those patients on dialysis. These drugs may also be effective for preserving residual renal function and peritoneal function for PD patients. β-blockers may have potentials to improve survival for HD patients and can be added to antihypertensive medications. Lacking large-scale and good quality clinical trials, there are many questions to be answered. Much effort should continuously be made to create evidences for better management of hypertension for patients on dialysis therapy.

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“…Some studies demonstrated that visit-tovisit BP variability was a novel risk factor for stroke (3), cardiovascular events (3), and all-cause mortality in the general population (6). It is reported that visit-to-visit BP variability also predicted cardiovascular events and allcause mortality in patients with chronic kidney disease (7,8) and hemodialysis (5,(9)(10)(11)(12)(13)(14). Note, however, that different dialysis modalities should have different effects on BP due to the intermittent nature of hemodialysis and continuous nature of peritoneal dialysis (PD).…”

Section: Introductionmentioning

confidence: 99%

e impact of visit-to-visit systolic blood pressure variability on residual renal function and le ventricular hypertrophy in peritoneal dialysis patients

Tian¹,

Wang²,

Tian³

et al. 2018

Turk J Med Sci

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Background/aim: Blood pressure (BP) variability is more closely associated with adverse outcomes than 'usual' BP in the general population. Residual renal function (RRF) and left ventricular hypertrophy (LVH) are thought to be predictors of poor outcome in dialysis patients. However, only a few studies have focused on BP variation and its link to RRF, LVH, and outcome in peritoneal dialysis (PD) patients. Therefore, we aimed to explore the effect of visit-to-visit BP variability on RRF and LVH in continuous ambulatory PD (CAPD) patients. Materials and methods:We performed an observational study that included all prevalent PD patients between 1 February 2006 and 31 January 2007. All patients underwent BP measurements, pulse wave velocity (PWV), cardiac ultrasound, and biochemical examination during the 1-year observation. Patients were divided into the HBPV group (higher BP variability) and LBPV group (lower BP variability) based on the standard deviation of systolic BP (SBP).Results: There were 70 patients recruited for the final analysis. Patients with HBPV had a higher SBP as compared to patients with LBPV at baseline. Renal Kt/V decreased significantly from 0.50 ± 0.49 to 0.32 ± 0.35 (P < 0.01) in HBPV group (but not in the LBPV group) during follow-up. Patients with HBPV also showed a higher left ventricular mass index (LVMI) and PWV than those with LBPV at the end of follow-up. Conclusion:Our study suggests that BP variability may affect RRF in PD patients. PD patients with HBPV had a faster decline in RRF and higher PWV and LVH.

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Pre-Dialysis Systolic Blood Pressure-Variability Is Independently Associated with All-Cause Mortality in Incident Haemodialysis Patients

Cited by 32 publications

References 21 publications

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

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

Management of hypertension for patients undergoing dialysis therapy

e impact of visit-to-visit systolic blood pressure variability on residual renal function and le ventricular hypertrophy in peritoneal dialysis patients

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