The Association between Frailty Status and Blood Pressure Variability in Chronic Kidney Disease Patients Undergoing Hemodialysis

Abstract

BACKGROUND: The high mortality rate of patients with chronic kidney disease undergoing hemodialysis (CKD-HD) is influenced by the high number of cardiovascular-induced death and blood pressure variability (BPV). AIM: The aim of this study is to understand the association between frailty status and intradialytic BPV. METHODS: This is a cross-sectional study examining patients with CKD who underwent hemodialysis (HD) at Dr. Cipto Mangunkusumo National General Hospital from August to September 2022. BPV was calculated using the average real variability method and frailty status was assessed based on Frailty Index 40 Item. The association between frailty and systolic BPV was analyzed using the Chi-Square test, followed by logistic regression analysis to exclude the influence of the confounding variable. RESULTS: Out of 88 subjects recruited, 28.4% (95% CI: 18.98–37.82) were considered frail, 55.7% (95% CI: 45.32–66.08) were pre-frail, and 15.9% (95% CI: 8.26–23.54) were robust. The mean intradialytic BPV was 10.11 (8.60–13.35). It was found that the trend increased along with the rising frailty status, and the mean difference of intradialytic systolic BPV based on the results of Kruskal–Wallis testing had statistical significance. The result of the multivariate analysis revealed an increase in BPV prevalence in patients with pre-frailty (adjusted PR = 1.606, 95% CI: 0.681–3.787) and frailty (adjusted PR = 1.886 (95% CI: 0.783–4.545). CONCLUSION: Statistically, there is no association between frailty status and intradialytic BPV. However, clinically, a dose-response association was observed, indicating that the higher the frailty status, the higher the prevalence ratio for the occurrence of high BPV.