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

Liao, Ri-Qiang; Li, Jiameng; Lin, Liwu; Sun, Si; Wang, Liya; Xiong, Yang; Li, Yupei; Han, Mei; Qiang, Liu; Su, Baihai

doi:10.1159/000496561

Cited by 8 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diastolic BPV has been reported to be associated with hemodialysis-related mortality [16], but this finding was not consistent in several other studies [10,[19][20][21]. Our analysis demonstrated that both systolic and diastolic BPV were significantly associated with all-cause mortality, whereas diastolic BPV failed to predict cardiovascular death.…”

Section: Discussioncontrasting

confidence: 86%

See 1 more Smart Citation

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

Zhao

Yang

et al. 2020

Kidney Dis

View full text Add to dashboard Cite

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).

show abstract

Section: Discussioncontrasting

confidence: 86%

“…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

View full text Add to dashboard Cite

show abstract

“…These alterations may subsequently affect the hemodynamic response of patients to ultrafiltration, thereby modifying their intradialytic BP profiles. The increased short-term BP variability with the consumption of intradialytic meals may also have prognostic implications if we take into consideration that observational studies have shown higher intradialytic BP variability to be associated with a higher risk for adverse cardiovascular events and mortality among patients on hemodialysis [ 18 , 19 ]. This risk association may be even stronger when increased BP variability is accompanied by a more frequent occurrence of symptomatic intradialytic hypotension, which is a serious and common dialysis-related complication that has also been associated with a heightened risk for cardiovascular morbidity and mortality [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Feeding during Dialysis Increases Intradialytic Blood Pressure Variability and Reduces Dialysis Adequacy

et al. 2022

View full text Add to dashboard Cite

Whether hemodialysis patients should be allowed or even encouraged to eat during dialysis remains a controversial topic. This cross-over study aimed to evaluate the impact of feeding during dialysis on intradialytic blood pressure (BP) profile and dialysis adequacy in 26 patients receiving thrice-weekly, in-center hemodialysis. Over three consecutive mid-week dialysis sessions, intradialytic BP was monitored using the Mobil-O-Graph device (IEM, Stolberg, Germany). Blood samples were also obtained for the determination of the urea reduction ratio (URR). At baseline, patients underwent dialysis without the provision of a meal. In phases A and B, a meal with either high-protein (1.5 gr/kg of body weight) or low-protein (0.7 gr/kg of body weight) content was administered 1 h after the initiation of dialysis. The sequence of meals (high-protein and low-protein or vice versa) was randomized. Average intradialytic systolic BP (SBP) was similar on all three occasions. However, compared with baseline, the standard deviation (SD) (11.7 ± 4.1 vs. 15.6 ± 7.6 mmHg, p < 0.01), coefficient of variation (CV) (9.5 ± 3.7% vs. 12.4 ± 6.0%, p < 0.01) and average real variability (ARV) (9.4 ± 3.9 vs. 12.1 ± 5.2 mmHg, p < 0.01) of intradialytic SBP were higher in phase A. Similarly, compared with the baseline evaluation, all three indices of intradialytic SBP variability were higher in phase B (SD: 11.7 ± 4.1 vs. 14.1 ± 4.5 mmHg, p < 0.05; CV: 9.5 ± 3.7% vs. 11.1 ± 3.8%, p < 0.05; ARV: 9.4 ± 3.9 vs. 10.9 ± 3.9 mmHg, p < 0.05). Compared with dialysis without a meal, the consumption of a high-protein or low-protein meal resulted in a lower URR (73.4 ± 4.3% vs. 65.7 ± 10.7%, p < 0.001 in phase A and 73.4 ± 4.3% vs. 67.6 ± 4.3%, p < 0.001 in phase B, respectively). In conclusion, in the present study, feeding during dialysis was associated with higher intradialytic SBP variability and reduced adequacy of the delivered dialysis.

show abstract

“…The full texts of the remaining 49 articles were reviewed, and 34 were excluded because the population, exposure, or outcomes were not of interest or the article was a review, editor's comment, or reference abstract. 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].…”

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%

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

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 8 publications

References 23 publications

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

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

Feeding during Dialysis Increases Intradialytic Blood Pressure Variability and Reduces Dialysis Adequacy

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

Contact Info

Product

Resources

About