Anika T Singh1,2, Sushrut S Waikar3,4, Finnian R Mc Causland1,2. 1. Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.T.S., F.R.M.C.). 2. Harvard Medical School, Boston, MA (A.T.S., F.R.M.C.). 3. Renal Section, Boston Medical Center, MA (S.S.W.). 4. Boston University School of Medicine (S.S.W.).
Abstract
BACKGROUND: Hypertension is common in hemodialysis patients. A subset of patients experience systolic blood pressure increases from prehemodialysis to posthemodialysis (intradialytic hypertension), which are associated with adverse outcomes. However, little consensus exists on an evidence-based definition. METHODS: In 3198 hemodialysis patients, Cox models were fit to examine the association of various definitions of intradialytic hypertension (≥30% of baseline sessions with an increase in prehemodialysis to posthemodialysis systolic blood pressure of (1) ≥0 mm Hg [Hyper0]; (2) ≥10 mm Hg [Hyper10], or (3) ≥20 mm Hg increase [Hyper20]) with all-cause mortality. Effect modification was assessed using interaction terms according to prespecified variables. RESULTS: At baseline, mean age was 62±15 years, 57% were male, and 14% of patients were Black. During the baseline period, 47% of individuals met the Hyper0 definition and experienced 32% (hazard ratio, 1.32 [95% CI, 1.05-1.66]) higher adjusted risk of death, compared with no systolic blood pressure increase. Hyper10 was present in 21.2% and associated with 18% higher adjusted risk of death (hazard ratio, 1.18 [95% CI, 0.94-1.48]). Hyper20 was present in 6.8% and associated with 3% higher adjusted risk of death (hazard ratio 1.03 [95% CI, 0.74-1.44]). Effect modification by age and peripheral vascular disease was observed (P interaction=0.04 for age and 0.02 for peripheral vascular disease), with higher associated risk of death for those aged 45 to 70 years and those without peripheral vascular disease. CONCLUSIONS: Individuals with any systolic blood pressure increase from prehemodialysis to posthemodialysis had the highest adjusted risk of mortality, compared with other threshold-based definitions.
BACKGROUND: Hypertension is common in hemodialysis patients. A subset of patients experience systolic blood pressure increases from prehemodialysis to posthemodialysis (intradialytic hypertension), which are associated with adverse outcomes. However, little consensus exists on an evidence-based definition. METHODS: In 3198 hemodialysis patients, Cox models were fit to examine the association of various definitions of intradialytic hypertension (≥30% of baseline sessions with an increase in prehemodialysis to posthemodialysis systolic blood pressure of (1) ≥0 mm Hg [Hyper0]; (2) ≥10 mm Hg [Hyper10], or (3) ≥20 mm Hg increase [Hyper20]) with all-cause mortality. Effect modification was assessed using interaction terms according to prespecified variables. RESULTS: At baseline, mean age was 62±15 years, 57% were male, and 14% of patients were Black. During the baseline period, 47% of individuals met the Hyper0 definition and experienced 32% (hazard ratio, 1.32 [95% CI, 1.05-1.66]) higher adjusted risk of death, compared with no systolic blood pressure increase. Hyper10 was present in 21.2% and associated with 18% higher adjusted risk of death (hazard ratio, 1.18 [95% CI, 0.94-1.48]). Hyper20 was present in 6.8% and associated with 3% higher adjusted risk of death (hazard ratio 1.03 [95% CI, 0.74-1.44]). Effect modification by age and peripheral vascular disease was observed (P interaction=0.04 for age and 0.02 for peripheral vascular disease), with higher associated risk of death for those aged 45 to 70 years and those without peripheral vascular disease. CONCLUSIONS: Individuals with any systolic blood pressure increase from prehemodialysis to posthemodialysis had the highest adjusted risk of mortality, compared with other threshold-based definitions.
Authors: Jula K Inrig; Peter Van Buren; Catherine Kim; Wanpen Vongpatanasin; Thomas J Povsic; Robert Toto Journal: Clin J Am Soc Nephrol Date: 2012-06-14 Impact factor: 8.237