PS-C18-8: MEAN ANNUAL INTRADIALYTIC BLOOD PRESSURE DECLINE AND CARDIOVASCULAR EVENTS IN JAPANESE MAINTENANCE HEMODIALYSIS PATIENTS

Abstract

Objective: A decline in the intradialytic systolic blood pressure (SBP), which defines intradialytic hypotension, is associated with a greater risk of intradialytic symptoms. Intradialytic SBP decline may be associated with higher all-cause mortality. However, this association has neither been studied in Japanese hemodialysis (HD) patients, nor has seasonal variations in intradialytic SBP decline been considered. We evaluated the association between the mean annual intradialytic SBP decline in Japanese HD patients and clinical outcomes, including major adverse cardiovascular events (MACEs). Design and method: This retrospective cohort study included 47,219 HD sessions in 307 patients undergoing HD over one year (April 2019 to March 2020) in three dialysis clinics. The mean annual intradialytic SBP decline (predialysis SBP-nadir intradialytic SBP) for each patient was determined. The association of the mean annual intradialytic SBP decline with clinical outcomes, including MACEs, was assessed from April 2020 until March 2022. MACEs included cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization. Results: The study participants included 202 males (66%). The mean patient age was 69.0 ± 12.4 years and the median duration of HD was 4.1 (2.0–7.7) years. The mean annual intradialytic SBP decline was 28.2 ± 14.8 mmHg. MACEs occurred in 77 cases (25%), death or hospitalization due to a decline in Activities of Daily Living (death or hospitalization) occurred in 56 (18%) cases, and all-cause hospitalization occurred in 184 cases (60%). A Cox regression analysis adjusted for age, sex, HD duration, Charlson comorbidity index, and the mean annual predialysis SBP and ultrafiltration rate, showed that a greater intradialytic SBP decline (per 10) was significantly associated with increased risk of MACEs (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.09–1.54). Moreover, the greater intradialytic SBP decline (per 10) was associated with increased risks of death or hospitalization (HR, 1.32; 95% CI, 1.08–1.62) and all-cause hospitalization (HR, 1.22; 95% CI, 1.07–1.39). Conclusions: In Japanese maintenance HD patients, a greater intradialytic SBP decline was associated with worse clinical outcomes, including increased risks of MACEs, death or hospitalization, and all-cause hospitalization. Further studies are warranted to investigate interventions to attenuate intradialytic SBP decline and improve the prognosis of Japanese HD patients.