Key result
Greater intradialytic BP changes worsened prognosis in patients with low interdialytic weight gain (P<0.05), whereas smaller BP changes increased mortality in those with high weight gain (P<0.05).
Why the study?
The impact of interdialytic weight gain on the association between intradialytic blood pressure changes and prognosis remained unclear, especially in hemodialysis patients without cardiac dysfunction and diabetes.
Does absolute intradialytic blood pressure change affect long-term mortality differently depending on interdialytic weight gain in hemodialysis patients?
Observational (n=204)
Does absolute intradialytic blood pressure change affect long-term mortality differently depending on interdialytic weight gain in hemodialysis patients?
p-value: p=<0.05
The impact of intradialytic blood pressure changes on long-term mortality in hemodialysis patients varies paradoxically depending on the degree of interdialytic weight gain.
Paradoxical mortality associations with intradialytic BP changes by IDWG; hypothesis-generating and should not yet change practice.
Background: A greater interdialytic weight gain (IDWG) implies a greater ultrafiltration rate, which might lead to hemodynamic instability and intradialytic blood pressure (BP) change in hemodialysis patients. However, current studies have not explicated the impact of IDWG on the association between intradialytic BP changes and prognosis, especially in patients without cardiac dysfunction and diabetes. In this study, we aimed to explore the relationship between absolute intradialytic BP changes and mortality with different IDWG levels. Methods: A total of 204 hemodialysis patients (without cardiac dysfunction and diabetes) were included in this prospective observation study, with a mean follow-up of 55.32± 20.99 months. Initially, we collected IDWG, IDWG% (percentages according to dry weight), and pre-/post-BPs of 36 consecutive dialysis sessions during three months enrollment. And the average value of them was defined as baseline value. Patients were divided into 3 cohorts according to IDWG% tertiles (< 3.3%, 3.3%– 4.6%, ≥ 4.6%). Comparisons between different tertiles were analyzed. Results: Compared to the low IDWG% group (tertile 1, T1), patients of high IDWG% group (tertile 3, T3) were younger, had higher ultrafiltration rate, less residual kidney function, lower BMI and dry weight, longer dialysis vintage and higher N terminal pro B type natriuretic peptide levels ( P < 0.05). Correlations were found between IDWG% and intradialytic BP changes. Kaplan–Meier analysis and multivariate Cox regression model adjusted for demographic data, dialysis information and predialysis BPs indicated that greater absolute intradialytic BP changes were associated with worse prognosis in T1 group ( P < 0.05). While in T3 group, less absolute intradialytic BP changes were associated with higher mortality ( P < 0.05). Conclusion: There is a paradoxical association between absolute intradialytic BP changes and long-term mortality with different IDWG levels. Both BP stability and volume balance are crucial to patients’ prognosis.
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Yu et al. (2021) conducted an observational in Hemodialysis (n=204). Absolute intradialytic blood pressure changes vs. Different levels of interdialytic weight gain was evaluated on Long-term mortality (p=<0.05). Greater intradialytic BP changes worsened prognosis in patients with low interdialytic weight gain (P<0.05), whereas smaller BP changes increased mortality in those with high weight gain (P<0.05).
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