Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients (original) (raw)
Hemodialysis International, 2004
Frequent or occasional symptomatic intradialytic hypotension during hemodialysis may influence patients' well being, but its effects on survival, independent of comorbidities, have not previously been investigated.Objective: To assess the effect of frequent (f-IDH) or occasional (o-IDH) dialysis-associated hypotension on survival.Methods: During the run in period in 1998, 77 patients with f-IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 prevalent chronic hemodialysis patients of a network. Eighty-five patients who had no hypotensive episodes (no-IDH) served as controls. Patients were followed for a median of 27 months (range 0.3–37), and survival of patients was compared by log-rank test. Independent association of f-IDH and o-IDH on survival, compared to no-IDH, was assessed by proportional hazards model that included patient's demographics, laboratory data, comorbidity as well as medications.Results: Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH, and 33 (39%) with no-IDH died during the follow up that represents mortality rates of 37 (p = 0.013 vs. no-IDH), 26 (p = 0.375 vs. no-IDH), and 21 deaths/100 patient years in the three groups, respectively. In multivariate proportional hazards regression, where age, sex, time on dialysis, CHD, diabetes, Kt/V, albumin level, use of beta-blockers, calcium-channel blockers, and long-acting nitrates have been adjusted for, neither f-IDH nor o-IDH was associated with survival.Conclusion: Mortality in patients with f-IDH is significantly higher than in those without such events. Our data, however, did not provide evidence that f-IDH, independent of age and comorbidities, contributes to mortality in these patients.
Kidney and Blood Pressure Research, 2012
Background: In incident hemodialysis (HD) patients, the relationship between early systolic blood pressure (SBP) dynamics and mortality is unknown. Methods: Baseline SBP levels were stratified into 5 categories ranging from <120 and ≥180 mm Hg. Early pre-HD SBP change was defined as the slope of pre-HD SBP from week 1 to 12 and categorized in quartiles (Q1, lowest slope). SBP slopes were computed for each patient by simple linear regression. Results: In 3,446 incident HD patients (42% females, 44% black, age 62 ± 15 years), the median pre-HD SBP slope was –1.7 (Q1) to +2.3 (Q4) mm Hg/week. In an adjusted multivariate Cox regression analysis, patients with declining SBP (slope Q1) had higher mortality compared to patients with increasing pre-HD SBP (slope Q4) at 12 months (hazard ratio 2.01, 95% confidence interval 1.35–3.01). In addition, patients with baseline pre-HD SBP <120 mm Hg showed higher mortality compared to the reference group (SBP ≥180 mm Hg) at 12 months (hazard r...