Abstract TP331: The Effect of Intradialytic Blood Pressure Variability Prior to Intracerebral Hemorrhage on Outcomes

Abstract

Introduction: Increased blood pressure variability (BPV) during chronic hemodialysis (HD) is associated with cardiovascular event and all-cause mortality. However, it is largely unknown whether pre-admission intradialytic BPV affects functional outcomes in patients with acute intracerebral hemorrhage (ICH). Methods: We examined consecutive patients with acute spontaneous ICH who had received HD from our prospective stroke registry between January 2012 and March 2019. Patients with premorbid modified Rankin Scale (mRS) score of 5 and patients who could not be obtained either pre-admission or post-admission blood pressure were excluded from the study. Pre-admission intradialytic BPV was quantified by systolic blood pressure successive variation (SBP-SV) from the last pre-admission dialysis record prior to ICH. Post-admission BPV during initial 24 hours was also quantified using SBP-SV. The clinical outcomes were hematoma expansion and unfavorable outcome at 3-months (mRS score of 5 to 6). Results: Of 54 ICH patients who had received HD, 45 patients were analyzed (median age, 68 years; male, 64%; non-lobar ICH, 93 %).Unfavorable outcome was observed in 26 (58%) patients.Increased pre-admission intradialytic SBP-SV was associated with only post-admission SBP-SV, but not associated with National Institute of Health Stroke Scale (NIHSS) score, hematoma volume, or hematoma expansion.In univariate analysis, both of pre- and post-admission SBP-SV were associated with unfavorable outcome. In analysis adjusting for age, NIHSS score, and hematoma volume, pre-admission SBP-SV (per SD; odds ratio, 3.70; 95% confidence interval, 1.01-13.6) was associated with unfavorable outcome, while post-admission SBP-SV was not independently associated with unfavorable outcome. Conclusions: In ICH patients who had received chronic HD, pre-admission intradialytic BPV was independently associated with unfavorable outcome after ICH, suggesting that BP control during HD may be a therapeutic target for avoiding further neurological aggravation even once ICH has occurred.