Association of Blood Pressure Increases During Hemodialysis With 2-Year Mortality in Incident Hemodialysis Patients: A Secondary Analysis of the Dialysis Morbidity and Mortality Wave 2 Study
Received 19 December 2008; accepted 13 May 2009. published online 31 July 2009.
Refers to article:
Peridialytic, Intradialytic, and Interdialytic Blood Pressure Measurement in Hemodialysis Patients
Arjun D. Sinha, Rajiv Agarwal
American Journal of Kidney Diseases
November 2009 (Vol. 54, Issue 5, Pages 788-791) Full Text |
Full-Text PDF (145 KB)
Background
Intradialytic increases in blood pressure (BP) can complicate the management of hypertension in hemodialysis (HD) patients. However, the long-term consequences are uncertain. Thus, we sought to determine whether BP increases during HD were associated with greater 2-year mortality in incident HD patients.
Study Design
Secondary analysis of a prospective dialysis cohort.
Setting & Participants
Incident HD patients in the Dialysis Morbidity and Mortality Wave 2 Study.
Predictors
Changes in systolic BP (SBP) during HD (ie, postdialysis SBP − predialysis SBP), averaged from 3 HD sessions before enrollment.
Outcome
Time to 2-year all-cause mortality.
Measurements
Cox regression was used to model hazard ratios for mortality associated with changes in SBP during HD while adjusting for demographics, comorbid conditions, interdialytic weight gain, laboratory variables, and antihypertensive agents.
Results
Of 1,748 patients, 12.2% showed greater than 10–mm Hg increases in SBP during HD. In adjusted analyses, every 10–mm Hg increase in SBP during HD was associated independently with a 6% increased hazard of death (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.11). When also adjusted for diastolic BP and postdialysis SBP, the adjusted hazard of death associated with increasing SBP during HD remained significant (hazard ratio, 1.12; 95% confidence interval, 1.05 to 1.21 per 10–mm Hg increase in SBP during HD). However, in analyses adjusted for predialysis SBP, there was a significant interaction between change in SBP and predialysis SBP. In analyses stratified by predialysis SBP, trends for increased mortality associated with increasing SBP during dialysis were present in patients with predialysis SBP less than 160 mm Hg. However, this relationship was significant only in patients with predialysis SBP less than 120 mm Hg.
Limitations
Secondary analysis with a limited number of baseline BP measurements and limited information about dialysis prescription.
Conclusions
Increasing SBP by more than 10 mm Hg during HD occurs in approximately 10% of incident patients, and although increasing SBP during HD was associated with decreased 2-year survival, these findings were limited to patients with predialysis SBP less than 120 mm Hg.
ABSTRACT