February 17, 2017Nephrology Dialysis Transplantation170 citationsOpen Access

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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: incident hemodialysis (n=112013). Intervention: Nadir intradialytic systolic blood pressure (niSBP) <90 mmHg vs. niSBP 110 to <120 mmHg. Primary outcome: 5-year all-cause mortality (HR 1.57, 95% CI 1.47-1.67).

JCJason A. ChouUniversity of California, Irvine ESElani StrejaUniversity of California, Irvine DNDanh V. NguyenUniversity of California, Irvine

Key Result

Nadir intradialytic systolic blood pressure <90 mmHg was associated with higher 5-year mortality compared with 110 to <120 mmHg (HR 1.57; 95% CI 1.47-1.67) in incident hemodialysis patients.

Study Design

Type

Cohort (n=112,013)

Structured PICO

Are nadir intradialytic systolic blood pressure, change in systolic blood pressure, and intradialytic hypotension frequency associated with all-cause mortality in incident hemodialysis patients?

Population

112,013 incident hemodialysis patients in a US-based cohort followed for up to 5 years to examine the association between intradialytic hypotension and mortality.

Exposure

Nadir intradialytic systolic blood pressure (niSBP), change in iSBP (ΔiSBP), and intradialytic hypotension (IDH) frequency (proportion of HD treatments with niSBP <90 mmHg) within the first 91 days of hemodialysis

Comparator

Reference categories (niSBP 110 to <120 mmHg, ΔiSBP 21-30 mmHg, 0% IDH frequency)

Outcome

All-cause mortality at 1, 2, and 5 yearshard clinical

There is a U-shaped association between nadir intradialytic systolic blood pressure and mortality, and a direct linear relationship between intradialytic hypotension frequency and mortality in incident hemodialysis patients.

Main Result

Hazard Ratio: 1.57 (95% CI 1.47–1.67)

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 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.

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Cite This Study

Chou et al. (Fri,) conducted a cohort in incident hemodialysis (n=112,013). Nadir intradialytic systolic blood pressure (niSBP) <90 mmHg vs. niSBP 110 to <120 mmHg was evaluated on 5-year all-cause mortality (HR 1.57, 95% CI 1.47-1.67). Nadir intradialytic systolic blood pressure <90 mmHg was associated with higher 5-year mortality compared with 110 to <120 mmHg (HR 1.57; 95% CI 1.47-1.67) in incident hemodialysis patients.

synapsesocial.com/papers/6a5f61c9c958949b46066027 https://doi.org/https://doi.org/10.1093/ndt/gfx037

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