Blood Pressure Variability and Dialysis

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: End-stage renal disease on hemodialysis (n=11291). Intervention: Predialysis systolic blood pressure variability vs. Lower blood pressure variability. Primary outcome: All-cause and cardiovascular morbidity and mortality.

Jennifer E. Flythe; Steven M. Brunelli

doi:10.1681/asn.2013111237

January 2, 2014Journal of the American Society of Nephrology

Blood Pressure Variability and Dialysis

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Key result

Greater visit-to-visit predialysis systolic blood pressure variability is associated with adverse clinical characteristics, while lower variability is linked to greater ultrafiltration volume, dry weight attainment, and non-beta-blocker/non-RAS-blocking antihypertensive regimens.

Structured PICO

P

Population

An editorial discussing an observational cohort of 11,291 incident hemodialysis patients evaluating the association between visit-to-visit predialysis systolic blood pressure variability and clinical outcomes.

E

Exposure

For Fabry disease: Reduced dosing of agalsidase-b (0.3-0.5 mg/kg every 2 weeks) or switch to agalsidase-a (0.2 mg/kg every 2 weeks). For hemodialysis: Visit-to-visit blood pressure variability.

C

Comparator

For Fabry disease: Standard enzyme replacement therapy dosing (agalsidase-b 1 mg/kg every 2 weeks).

O

Outcome

For Fabry disease: eGFR, albumin/creatinine ratio, and patient-reported symptoms. For hemodialysis: All-cause and cardiovascular morbidity and mortality.

Limitations

Did not include measures of sodium balance or objective measures of volume status
Does not take into account intradialytic hemodynamic measures
Did not examine the effects of specific antihypertensive classes within regimen categories
Did not account for patient adherence to antihypertensive agents and administration timing
Decisions about dosing regimens were based on consensus-based clinical criteria and not on a randomized prospective study design
More severely affected patients were in the stable agalsidase-b group
Short follow-up time of 1 year for the Fabry disease study
Did not include measures of sodium balance or objective measures of volume status in the hemodialysis study

Implication

Dose reduction of enzyme replacement therapy in Fabry disease may lead to worsened symptoms and renal function decline, while in hemodialysis, visit-to-visit blood pressure variability is a prognostic indicator influenced by antihypertensive regimens.

Discussion

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Cite This Study

Flythe et al. (2014) conducted an editorial in End-stage renal disease on hemodialysis (n=11,291). Predialysis systolic blood pressure variability vs. Lower blood pressure variability was evaluated on All-cause and cardiovascular morbidity and mortality. Greater visit-to-visit predialysis systolic blood pressure variability is associated with adverse clinical characteristics, while lower variability is linked to greater ultrafiltration volume, dry weight attainment, and non-beta-blocker/non-RAS-blocking antihypertensive regimens.

synapsesocial.com/papers/6a99be9564ef13a13d7b8b4d https://doi.org/10.1681/asn.2013111237

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Blood Pressure Variability and Dialysis

Structured PICO

Limitations

Implication

Discussion

Cite This Study

Blood Pressure Variability and Dialysis

Structured PICO

Limitations

Implication

Discussion

Cite This Study

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