The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients

Sarafidis, Pantelis A.; Loutradis, Charalampos; Καρπέτας, Αντώνιος; Tzanis, Georgios; Bikos, Athanasios; Raptis, Vasileios; Syrgkanis, Christos; Liakopoulos, Vassilios; Papagianni, Αikaterini; Bakris, George L.; Parati, Gianfranco

doi:10.1093/ndt/gfy247

Cited by 41 publications

(29 citation statements)

References 35 publications

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“…We observed that all indices examined were significantly higher during the 2nd in comparison to the 1st 24-h period of the interdialytic interval [3]. In a subsequent prospective cohort study of 227 patients and average 2.5 years of follow-up, we observed that all of SD, wSD, CV, and ARV indexes measured over the 48-h period were associated to the future risk of cardiovascular events and mortality [16], thus adding BPV to the complex set of factors involved in the adverse cardiovascular profile of hemodialysis individuals.…”

Section: Discussionmentioning

confidence: 59%

“…A recent study that examined short-term BPV by 24-h ABPM in a large sample of hypertensive patients with different stages of CKD has shown that BPV is increasing as CKD stage advances [15]. In hemodialysis, we recently showed that BPV is increased from Day 1 to Day 2 of the interdialytic interval [3], and that all indexes of BPV are associated with increased risk of cardiovascular events and death [16]. We have also recently showed that nebivolol and irbesartan are able to reduce ambulatory BP in patients with intradialytic hypertension [17].…”

Section: Introductionmentioning

confidence: 99%

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A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

et al. 2018

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Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

et al. 2018

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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, 20-25, 35-42]. Results from 2 studies did not provide sufficient data for the pooled analysis [22, 42].…”

Section: Resultsmentioning

confidence: 99%

“…Studies have found an association between the mean BP and outcomes in patients on HD [15-17]. Over the last decade, more studies have explored the impact of BPV on the prognosis of HD patients, with inconsistent results [18-25]. 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

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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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“…Excessive interdialytic fluid gains contribute to the development of LVH 25 and associate with worse outcomes, 26 although recent data suggest that this association is also affected by an interaction with nutritional status 27 . The degree to which blood pressure varies in the interdialytic period also has been linked to worse outcomes, 28 and the longer interdialytic gap is associated with increased rates of sudden cardiac death in HD patients. 24 Earlier studies reported that mortality events occurred in a bimodal distribution, with mortality more common at the end of and immediately after the long interdialytic gap, suggesting that both accumulation and fluctuations of fluid/uremic toxins with dialysis lead to higher mortality.…”

Section: Dialysis-induced Myocardial Hypoperfusion Has Been Directly mentioning

confidence: 99%

Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn't it better than hemodialysis?

Selby

Kazmi

2018

Seminars in Dialysis

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Rates of cardiovascular mortality are disproportionately high in patients with end stage kidney disease receiving dialysis. However, it is now generally accepted that patient survival is broadly equivalent between the two most frequently used forms of dialysis, in‐center hemodialysis (HD) and peritoneal dialysis (PD). This equivalent patient survival is notable when considering how specific aspects of HD have been shown to contribute to morbidity and mortality. These include more rapid loss of residual renal function (RRF), HD‐induced myocardial and cerebral ischemia, and risk factors associated with the intermittent delivery of HD. Potential mechanisms specific to PD that may drive cardiovascular disease include the metabolic consequences of excessive absorption of glucose and glucose degradation products (GDPs), inadequate volume control, and high rates of hypokalemia. The aim of this review is to compare and contrast the different drivers of adverse outcomes between the dialysis modalities, as greater understanding of this may help in patient‐centered decision‐making when considering options for renal replacement therapy.

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The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients

Cited by 41 publications

References 35 publications

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

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

Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn't it better than hemodialysis?

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