Abstract
Objective: To investigate the association of short-term blood pressure variability (BPV) with cardiovascular mortality in hemodialysis (HD) patients, using a reliable index called average real variability (ARV), and to assess the factors associated with ARV in incident HD population.Methods: A total of 103 HD patients were recruited, with 44-h ambulatory blood pressure monitoring performed after the midweek HD session. Systolic BPV was assessed by SD, coefficient of variation (CV), and ARV, respectively. Laboratory data were obtained from blood samples before the midweek HD. All patients were followed up for 24 months.Results: According to the median of BPV indices, the comparisons between patients with the low and high values were conducted. Kaplan–Meier analysis showed the survival curves corresponding to median of SD and CV exhibit similar performance for the low and high groups (p = .647, p = .098, respectively). In contrast, patients with higher ARV had a lower survival rate than those with lower ARV (77.8% vs. 98.0%, p = .002). After adjustment for demographics and clinical factors, ARV (HR: 1.143; 95% CI: 1.022–1.279, p = .019) and high-sensitivity C-reactive protein (HR: 1.394; 95% CI: 1.025–1.363, p = .021) were associated with increased risk of cardiovascular mortality in HD patients. Age and interdialytic weight gain (IDWG) were related factors for ARV (β = 0.065, p = .005; β = 0.825, p = .003, respectively).Conclusions: Greater ARV was independently associated with increased risk of cardiovascular mortality in HD patients. Age and IDWG were independent related factors for ARV.
Highlights
End stage renal disease (ESRD) is associated with a 3- to 10-fold increased risk of cardiovascular events as compared with general populations [1,2]
Dialysis patients are routinely exposed to nonphysiologic fluid and osmolar shifts during the dialytic procedure that, combined with impaired counter-regulatory responses, promote more prominent blood pressure (BP) changes than are encountered in almost any other clinical circumstance
Short-term blood pressure variability (BPV) is usually measured by ambulatory BP monitoring during specified short-time intervals. 44-h interdialytic ambulatory BP measurement is the most commonly used method, because of both an increased variability and the gradual increase in BP between dialysis [10,11]
Summary
End stage renal disease (ESRD) is associated with a 3- to 10-fold increased risk of cardiovascular events as compared with general populations [1,2]. Blood pressure (BP) per se, may not fully characterize the pathophysiologic relationship between BP and cardiovascular outcomes. Other factors, such as blood pressure variability (BPV), are prognostically important. Existing data linking BPV from ambulatory blood pressure monitoring (ABPM) with all-cause mortality in the general population are robust [5–7]. In hemodialysis (HD) population, ambulatory BP has been demonstrated to be the best predictor of all-cause mortality in a long-term follow-up study compared with pre- or post-dialysis BP [8]. Sparse data are available regarding the association of ambulatory BPV with outcomes in dialysis patients
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