Abstract
Objective: The objective of this study is to investigate the relationship between blood pressure changes and all-cause mortality, and between blood pressure changes and cardiovascular mortality, for maintenance hemodialysis (MHD) patients during dialysis.Methods: Data regarding general condition, biochemical indices, and survival prognosis of MHD patients who were treated at the Shanghai Jiao Tong University School of Medicine-affiliated Renji Hospital from July 2007 to December 2012 were collected, in order to evaluate the relationship between patients’ blood pressure changes during hemodialysis and mortality.Results: Among 364 patients, with an average age of 63.07 ± 13.93 years, an average dialysis vintage of 76.00 (range, 42.25–134.00) months, and a follow-up time of 54.86 ± 19.84 months, there were 85 cases (23.4%) of all-cause death and 46 cases (14.2%) of cardiovascular death. All-cause mortality and cardiovascular mortality were lowest (OR, 0.324 and 0.335; 95% CI, 0.152–0.692 and 0.123–0.911; p value, .004 and .032, respectively) in patients whose systolic blood pressure difference (ΔSBP) before and after dialysis was between 7.09 and 14.25 mmHg. Kaplan–Meier analysis indicated that both all-cause mortality and cardiovascular mortality were markedly increased for patients with ΔSBPless than −0.25 mmHg (p value, .001 and .044, respectively). Cox regression analysis showed that ΔSBP< −0.25 mmHg, hemoglobin concentration, Kt/v and albumin were independent risk factors for all-cause mortality in MHD patients.Conclusions: MHD patients whose blood pressure increased significantly after hemodialysis had a higher risk of dying; ΔSBP, hemoglobin concentration, Kt/v and albumin were independent risk factors for all-cause mortality in MHD patients.
Highlights
364 maintenance hemodialysis (MHD) patients were investigated, and the results showed that patients with DSBP< À0.25 mmHg during dialysis had higher mortality, while those patients whose systolic blood pressure (SBP) moderately decreased had a higher survival rate
The increase in SBP during hemodialysis was closely related to the increase in mortality, and SBP is increased in about 10–15% of patients after dialysis, according to some studies.[8]
Previous studies have shown that SBP increase during hemodialysis is a sign of poor prognosis in the short term.[9]
Summary
Four hundred and two patients, who were registered in the Shanghai Dialysis Registration System and have received !3 months of MHD treatment at the Shanghai Jiao Tong University Medical School-affiliated Renji Hospital from 1 July 2007 to 31 December 2012, were selected. Thirty-eight of them were excluded due to incomplete registration data, and the remaining 364 patients were included in the study. Patients’ demographic and clinical data were collected, including gender, age, height, dry weight, dialysis vintage, blood pressure before and after dialysis, biomedical indices, etc. Research methods (1) Blood biochemical indices, including average values of corrected calcium (Ca2þ), phosphate (P3þ), intact parathyroid hormone (iPTH), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL), cholesterol, albumin (Alb), hemoglobin (Hb), and high-sensitivity C-reactive protein (hsCRP), were tested, and Kt/v were calculated for all patients. (2) Blood pressure was recorded for all patients before and after hemodialysis at first hemodialysis of every season. General conditions of patients in the four groups were compared with each other
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