Jinbo Yu1,2,3, Xiaohong Chen1,2,3, Yaqiong Wang1,2,3, Zhonghua Liu1,2,3, Bo Shen1,2,3, Jie Teng1,2,3, Jianzhou Zou1,2,3, Xiaoqiang Ding4,5,6. 1. Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. 2. Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China. 3. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China. 4. Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn. 5. Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn. 6. Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China. ding.xiaoqiang@zs-hospital.sh.cn.
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.
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%) patientsdied (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.
Authors: Jennifer E Flythe; Hui Xue; Katherine E Lynch; Gary C Curhan; Steven M Brunelli Journal: J Am Soc Nephrol Date: 2014-09-30 Impact factor: 10.121
Authors: Bergur V Stefánsson; Steven M Brunelli; Claudia Cabrera; David Rosenbaum; Emmanuel Anum; Karthik Ramakrishnan; Donna E Jensen; Nils-Olov Stålhammar Journal: Clin J Am Soc Nephrol Date: 2014-11-06 Impact factor: 8.237