Abstract
Because hypotension during hemodialysis (HD) makes continuation of HD difficult and is associated with mortality, pressor approaches are necessary for patients with hypotension. However, the relationships between the pressor approaches and the risk of death have not been clarified yet. We analyzed data from a nationwide prospective cohort study of the Japanese Society for Dialysis Therapy Renal Data Registry (n = 29,309). The outcome was all-cause one-year death. The association between the use of pressor approaches and the outcome was examined using Cox proportional hazards models adjusted for baseline characteristics, propensity score matched analysis and Bayesian networks. The background features of the patients were as follows: male, 59.6%; average age, 64.5 ± 12.5 years; and patients with diabetes mellitus, 31.5%. The pressor group showed a higher risk of the outcome than the control group [adjusted hazard ratio (aHR) 1.33 (95% CI: 1.21, 1.47), p = 0.0001]. Propensity score matched analysis also showed that the matched-pressor group had a higher risk of the outcome than the matched-control group [aHR 1.30 (95% CI: 1.17, 1.45), p = 0.0001]. Moreover, the Bayesian network showed a direct causal relationship from the use of pressor approaches to the outcome. The use of oral vasopressors [aHR 1.20 (95% CI: 1.07, 1.35), p = 0.0018], intravenous injection of vasopressors [aHR 1.54 (95% CI: 1.32, 1.79), p = 0.0001] and normal saline [aHR 1.18 (95% CI: 1.05, 1.33), p = 0.0066] were associated with a high risk of the outcome. In conclusion, this study showed that the use of pressor approaches during HD may be an independent risk factor for death.
Highlights
Because hypotension during hemodialysis (HD) makes continuation of HD difficult and is associated with mortality, pressor approaches are necessary for patients with hypotension
Because observational analyses of pressor approaches and outcomes are subject to bias owing to unmeasured confounders, propensity score matched analysis was used in this study to minimize the bias, which showed that the pressor group had high risk of all-cause death
Bayesian network (BN) suggested that all-cause death was directly affected by the use of pressor approaches
Summary
Because hypotension during hemodialysis (HD) makes continuation of HD difficult and is associated with mortality, pressor approaches are necessary for patients with hypotension. It has been reported that post-HD systolic blood pressures higher than 180 mmHg and lower than 110 mmHg indicated a high risk of CVD-caused death in HD patients[2]. The relationship between post-HD systolic blood pressure and CVD-caused death showed a U-shape. According to the Annual Dialysis Data Report 2005 of the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry (JRDR), which is a nationwide renal data registry and contains data of all dialysis patients (n = 232,226) in Japan, the percentages of HD patients with post-HD systolic blood pressures lower than 100 mmHg and higher than 180 mmHg were 5.0% and 5.3%, respectively[3]. The dialysis outcomes and practice patterns study (DOPPS) showed that the risk of death in HD patients is high at a pre-HD systolic blood pressure of lower than 130 mmHg6. A systematic review of ten studies showed that post-HD systolic and diastolic blood pressures were increased by midodrine www.nature.com/scientificreports/
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