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Intradialytic systolic blood pressure variation can predict long-term mortality in patients on maintenance hemodialysis

  • Nephrology - Original Paper
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Abstract

Purpose

It is unclear which time-points of intradialytic blood pressure (BP) best predict prognosis. Thus, it is important to assess the association between different time-points of intradialytic BP and prognosis in clinical practice.

Methods

We recruited patients who underwent hemodialysis from January 2014 to June 2014. Data about dialysis were collected, including intradialytic BP. Cox regression analysis was performed to examine the association between different time-points of intradialytic BP and clinical events, with a follow-up through December 31, 2019. The primary endpoint was all-cause mortality.

Results

A total of 216 patients were recruited and 62 (30.7%) patients died (6.1 per 100-person year) during the follow-up. Intradialytic SBP varied greatly in fatalities. Univariate and multivariate Cox regression models indicated that the adjusted hazard ratio for death was 1.80 and 5.06 when intradialytic systolic blood pressure (SBP) variation was analyzed in increments of 20 mmHg. Furthermore, we divided intradialytic SBP variation into three categories: < 15 mmHg, 15 ~ 30 mmHg,  ≥ 30 mmHg. Kaplan–Meier analysis indicated that both all-cause mortality and cardiovascular mortality increased significantly for patients with intradialytic SBP variation over 30 mmHg (P = 0.006 and 0.021). Univariate and multivariate Cox regression models indicated that the adjusted hazard ratio for death was 3.78 and 12.62 as intradialytic SBP variation ≥ 30 mmHg vs. intradialytic SBP variation < 15 mmHg.

Conclusion

Intradialytic SBP variation, rather than BP of specific intradialytic time-points, has the potential to predict long-term mortality in hemodialysis patients. BP stability is crucial for patients’ prognosis.

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Acknowledgements

The authors are grateful to all participating patients and dialysis staff of Blood Purification Center, Division of Nephrology, Zhongshan Hospital, Fudan University. This study is supported by the National Natural Science Foundation of China (Grant no. 81903969), the Youth Foundation of Zhongshan Hospital (Grant no. 2019ZSQN22), Shanghai "science and technology innovation plan" technical standard project (No. 19DZ2205600), as well as by Shanghai Municipal Hospital Frontier Technology Project supported by Shanghai ShenKang Hospital Development Center (No. SHDC12018127).

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Authors and Affiliations

  1. Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Jinbo Yu, Xiaohong Chen, Yaqiong Wang, Zhonghua Liu, Bo Shen, Jie Teng, Jianzhou Zou & Xiaoqiang Ding

  2. Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People’s Republic of China

    Jinbo Yu, Xiaohong Chen, Yaqiong Wang, Zhonghua Liu, Bo Shen, Jie Teng, Jianzhou Zou & Xiaoqiang Ding

  3. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People’s Republic of China

    Jinbo Yu, Xiaohong Chen, Yaqiong Wang, Zhonghua Liu, Bo Shen, Jie Teng, Jianzhou Zou & Xiaoqiang Ding

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  1. Jinbo Yu
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  2. Xiaohong Chen
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  3. Yaqiong Wang
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Correspondence to Xiaoqiang Ding.

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The study was approved by our institution’s clinical research ethics review board (Ethics Committee of Zhongshan Hospital, Fudan University) and was conducted according to the Declaration of Helsinki principles. Written informed consent was obtained from all participants.

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Yu, J., Chen, X., Wang, Y. et al. Intradialytic systolic blood pressure variation can predict long-term mortality in patients on maintenance hemodialysis. Int Urol Nephrol 53, 785–795 (2021). https://doi.org/10.1007/s11255-020-02701-w

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