Key result
Higher intra-dialytic blood pressure variability was significantly associated with increased cardiovascular events (HR 1.70) in hemodialysis patients, outperforming visit-to-visit variability.
Why the study?
Short- and long-term blood pressure variability are cardiovascular and mortality risk factors in hemodialysis, but no full consensus exists on the best metric.
Does intra-dialytic blood pressure variability predict cardiovascular events better than visit-to-visit variability in hemodialysis patients?
Cohort (n=120)
No
Does intra-dialytic blood pressure variability predict cardiovascular events better than visit-to-visit variability in hemodialysis patients?
Hazard Ratio: 1.7 (95% CI 1.28–2.27)
p-value: p=<0.01
Intra-dialytic blood pressure variability is a stronger predictor of cardiovascular events than visit-to-visit variability in hemodialysis patients.
May support monitoring intra-dialytic BP variability in hemodialysis; leaves open whether targeting it reduces events.
BACKGROUND: Short-term and long-term blood pressure variability (BPV) in hemodialysis (HD) population are risk factors of cardiovascular diseases (CVD) and all-cause mortality. There is no full consensus on the best BPV metric. We compared the prognostic role of intra-dialytic and visit-to-visit BPV metrics for CVD morbidity and all-cause mortality in HD patients. METHODS: A retrospective cohort of 120 patients on HD was followed up for 44 months. Systolic blood pressure (SBP) and baseline characteristics were collected for 3 months. We calculated intra-dialytic and visit-to-visit BPV metrics, including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), average real variability (ARV) and residual. The primary outcomes were CVD events and all-cause mortality. RESULTS: In Cox regression analysis, both intra-dialytic and visit-to-visit BPV metrics were associated with increased CVD events (intra-dialytic CV: HR 1.70, 95% CI 1.28-2.27, p < 0.01; visit-to-visit CV: HR 1.55, 95% CI 1.12-2.16, p < 0.01), but not associated with increased all-cause mortality (intra-dialytic CV: HR 1.32, 95% CI 0.99-1.76, p = 0.06; visit-to-visit CV: HR 1.22, 95% CI 0.91-1.63, p = 0.18). Overall, intra-dialytic BPV showed greater prognostic ability than visit-to-visit BPV for both CVD event (AUC of intra-dialytic BPV and visit-to-visit BPV metrics respectively: SD 0.686, 0.606; CV 0.672, 0.425; VIM 0.677, 0.581; ARV 0.684, 0.618; residual 0.652, 0.586) and all-cause mortality (SD 0.671, 0.608; CV 0.662, 0.575; VIM 0.669, 0.581; ARV 0.529, 0.588; residual 0.651, 0.602). CONCLUSION: Compared to visit-to-visit BPV, intra-dialytic BPV is a greater predictor of CVD event in HD patients. No obvious priority was found among various BPV metrics.
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Liu et al. (2023) conducted a cohort in End-stage renal disease on hemodialysis (n=120). High intra-dialytic blood pressure variability vs. Low intra-dialytic blood pressure variability was evaluated on Cardiovascular events (HR 1.70, 95% CI 1.28-2.27, p=<0.01). Higher intra-dialytic blood pressure variability was significantly associated with increased cardiovascular events (HR 1.70) in hemodialysis patients, outperforming visit-to-visit variability.
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