Format

Send to

Choose Destination
Nephrol Dial Transplant. 2018 Jan 1;33(1):149-159. doi: 10.1093/ndt/gfx037.

Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients.

Author information

1
Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
2
Department of Medicine, University of California, Irvine, School of Medicine, Orange, CA, USA.
3
Quintiles Therapeutic Science and Strategy Unit, San Diego, California.
4
Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
5
Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA.
6
Division of Nephrology and Hypertension, Kaiser Permanente Medical Center, Los Angeles, CA, USA.
7
Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
8
Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.

Abstract

Background:

Intradialytic hypotension (IDH) occurs frequently in maintenance hemodialysis (HD) patients and may be associated with higher mortality. We hypothesize that nadir intradialytic systolic blood pressure (niSBP) is inversely related to death risk while iSBP change (Δ) and IDH frequency are incrementally associated with all-cause mortality.

Methods:

In a US-based cohort of 112 013 incident HD patients over a 5-year period (2007-11), using niSBP, ΔiSBP (pre-HD SBP minus niSBP) and IDH frequency (proportion of HD treatments with niSBP <90 mmHg) within the first 91 days of HD, we examined mortality-predictability at 1, 2 and 5 years using Cox models and restricted cubic splines adjusted for case-mix, comorbidities and laboratory covariates.

Results:

We observed that niSBP of <90 and ≥140 mmHg had a 5-year mortality hazard ratio (HR) (95% confidence interval) of 1.57 (1.47-1.67) and 1.25 (1.18-1.33), respectively, compared with niSBP 110 to <120 mmHg. ΔiSBP of <15 and ≥50 compared with 21-30 mmHg had mortality HR of 1.31 (1.26-1.37) and 1.32 (1.24-1.39), respectively. Among patients with >40% IDH frequency, we observed a mortality HR of 1.49 (1.42-1.57) compared with 0% IDH frequency in fully adjusted models. These associations were robust at 1 and 2 years of follow-up.

Conclusion:

In conclusion, we observed a U-shaped association between niSBP and ΔiSBP and mortality and a direct linear relationship between IDH frequency and mortality. Our findings lend some prognostic insight of HD blood pressure and hemodynamics, and have the potential to guide blood pressure management strategies among the HD population.

KEYWORDS:

blood pressure; hemodialysis; intradialytic hypotension; mortality; nutrition

PMID:
28444336
PMCID:
PMC5837776
DOI:
10.1093/ndt/gfx037
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center