Key result
Declining early pre-hemodialysis systolic blood pressure was associated with higher 12-month mortality compared to increasing blood pressure (HR 2.01; 95% CI 1.35-3.01).
Why the study?
Are early systolic blood pressure changes and baseline SBP levels associated with mortality in incident hemodialysis patients?
Cohort (n=3,446)
Are early systolic blood pressure changes and baseline SBP levels associated with mortality in incident hemodialysis patients?
Hazard Ratio: 2.01 (95% CI 1.35–3.01)
In incident hemodialysis patients, low baseline pre-HD SBP (<120 mm Hg) and declining early SBP dynamics are associated with increased mortality in the first year.
Early SBP decline may flag higher mortality risk in incident HD patients; hypothesis-generating and requires prospective validation before informing care.
BACKGROUND: In incident hemodialysis (HD) patients, the relationship between early systolic blood pressure (SBP) dynamics and mortality is unknown. METHODS: Baseline SBP levels were stratified into 5 categories ranging from <120 and ≥180 mm Hg. Early pre-HD SBP change was defined as the slope of pre-HD SBP from week 1 to 12 and categorized in quartiles (Q1, lowest slope). SBP slopes were computed for each patient by simple linear regression. RESULTS: In 3,446 incident HD patients (42% females, 44% black, age 62 ± 15 years), the median pre-HD SBP slope was -1.7 (Q1) to +2.3 (Q4) mm Hg/week. In an adjusted multivariate Cox regression analysis, patients with declining SBP (slope Q1) had higher mortality compared to patients with increasing pre-HD SBP (slope Q4) at 12 months (hazard ratio 2.01, 95% confidence interval 1.35-3.01). In addition, patients with baseline pre-HD SBP <120 mm Hg showed higher mortality compared to the reference group (SBP ≥180 mm Hg) at 12 months (hazard ratio 1.89, 95% confidence interval 1.03-3.45). CONCLUSION: Baseline pre-HD SBP and early SBP dynamics are associated with mortality in the first year of dialysis. Patients who had low (pre-HD SBP <120 mm Hg) or declining SBP had the highest mortality rates. Particular attention is warranted in incident HD patients with low or declining SBP.
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Sipahioğlu et al. (2012) conducted a cohort in Incident hemodialysis (n=3,446). Declining early pre-hemodialysis systolic blood pressure (slope Q1) vs. Increasing pre-hemodialysis systolic blood pressure (slope Q4) was evaluated on Mortality at 12 months (HR 2.01, 95% CI 1.35-3.01). Declining early pre-hemodialysis systolic blood pressure was associated with higher 12-month mortality compared to increasing blood pressure (HR 2.01; 95% CI 1.35-3.01).
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