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Mean annual intradialytic blood pressure decline and cardiovascular events in Japanese patients on maintenance hemodialysis

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A Comment to this article was published on 17 April 2023

Abstract

An intradialytic systolic blood pressure (SBP) decline, which defines intradialytic hypotension, may be associated with higher all-cause mortality. However, in Japanese patients on hemodialysis (HD), the association between intradialytic SBP decline and patient outcomes is unclear. This retrospective cohort study included 307 Japanese patients undergoing HD over 1 year in three dialysis clinics and evaluated the association between the mean annual intradialytic SBP decline (predialysis SBP-nadir intradialytic SBP) and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) by following up for 2 years. The mean annual intradialytic SBP decline was 24.2 (25–75th percentile, 18.3–35.0) mmHg. In the model fully adjusted for intradialytic SBP decline tertile group (T1, <20.4 mmHg; T2, 20.4 to <29.9 mmHg; T3, ≥29.9 mmHg), predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, use of renin–angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, geriatric nutritional risk index, normalized protein catabolism rate, C-reactive protein, hemoglobin, and use of pressor agents, Cox regression analyses showed that the hazard ratio (HR) was significantly higher for T3 than for T1 for MACEs (HR, 2.38; 95% confidence interval 1.12–5.09) and all-cause hospitalization (HR, 1.68; 95% confidence interval 1.03–2.74). Therefore, in Japanese patients on HD, a greater intradialytic SBP decline was associated with worse clinical outcomes. Further studies are warranted to investigate whether interventions to attenuate the intradialytic SBP decline will improve the prognosis of Japanese patients on HD.

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Acknowledgements

The authors thank all the participants of this research project.

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Authors and Affiliations

  1. Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan

    Rina Takahashi, Kiyotaka Uchiyama, Takashin Nakayama, Takeshi Kanda & Hiroshi Itoh

  2. Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan

    Naoki Washida

  3. Shibagaki Dialysis Clinic Jiyugaoka, Tokyo, Japan

    Keigo Shibagaki

  4. Department of Nephrology, Tokyo Shinagawa Hospital, Tokyo, Japan

    Akane Yanai

  5. Biostatistics Unit, Clinical, and Translational Research Center, Keio University Hospital, Tokyo, Japan

    Kengo Nagashima & Yasunori Sato

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  1. Rina Takahashi
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  2. Kiyotaka Uchiyama
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Correspondence to Kiyotaka Uchiyama.

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This study and all its protocols were reviewed and approved by the ethics committee of our hospital, and informed consent was obtained from all patients prior to their participation.

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Takahashi, R., Uchiyama, K., Washida, N. et al. Mean annual intradialytic blood pressure decline and cardiovascular events in Japanese patients on maintenance hemodialysis. Hypertens Res 46, 1536–1546 (2023). https://doi.org/10.1038/s41440-023-01228-8

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