Key result
The lowest quintile of pre-dialysis systolic blood pressure (<134 mm Hg) was associated with a significantly increased risk of all-cause mortality (HR 1.83) compared to the reference group (148-158 mm Hg).
Why the study?
The influence of pre-dialysis blood pressure on the prognosis of hemodialysis patients remains inconclusive.
Does pre-dialysis blood pressure level predict all-cause mortality and cardiovascular events in hemodialysis patients?
Cohort (n=3,436)
Yes
Does pre-dialysis blood pressure level predict all-cause mortality and cardiovascular events in hemodialysis patients?
Pre-dialysis blood pressure exhibits a U-shaped association with mortality and cardiovascular events in hemodialysis patients, suggesting optimal targets (SBP ~152 mm Hg) may be higher than those recommended for the general population.
Answers are grounded in this paper and cite their sources.
Does not justify aggressive BP reduction in hemodialysis; extends observational U-shaped risk data but leaves targets open for RCTs.
The influence of pre-dialysis blood pressure (BP) on the prognosis of hemodialysis (HD) patients is still inconclusive.A total of 3436 HD patients were prospectively followed up for 4 years. The patients were divided into quintiles of pre-dialysis systolic BP (SBP) and diastolic BP (DBP) levels [mm Hg]: Quintile 1 (Q1), SBP <134, DBP <66; Q2, SBP 134 to 147, DBP 66 to 72; Q3, SBP 148 to 158, DBP 73 to 79; Q4, SBP 159 to 171, DBP 80 to 85; Q5, SBP ≥172, DBP ≥86. The association between the pre-dialysis BP and outcomes were examined using a Cox proportional hazards model.During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed cardiovascular (CV) events. The lowest level of pre-dialysis SBP group (Q1) showed a significantly increased risk of all-cause mortality (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40-2.39) and the highest group (Q5) significantly increased risk of CV events (HR 1.31, 95% CI 1.02-1.68) compared with the reference group (Q3), respectively. The highest level of pre-dialysis DBP group was significantly associated with increased risk for both all-cause mortality and CV events. Restricted cubic spline analysis for BP and outcomes suggested the optimal pre-dialysis BP value associated with the lowest risk of outcomes was SBP 152 mm Hg for all-cause mortality, SBP 143 mm Hg for CV events, and DBP 68 mm Hg for all-cause mortality.Our results suggested that pre-dialysis BP was independently associated with all-cause mortality and CV events among Japanese HD patients.
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Hara et al. (2018) conducted a cohort in Hemodialysis (n=3,436). Pre-dialysis systolic blood pressure <134 mm Hg vs. Pre-dialysis systolic blood pressure 148-158 mm Hg was evaluated on All-cause mortality (HR 1.83, 95% CI 1.40-2.39, p=<0.001). The lowest quintile of pre-dialysis systolic blood pressure (<134 mm Hg) was associated with a significantly increased risk of all-cause mortality (HR 1.83) compared to the reference group (148-158 mm Hg).
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