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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Kidney+Dis
2013 ; 61
(6
): 966-74
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English Wikipedia
Association of intradialytic blood pressure variability with increased all-cause
and cardiovascular mortality in patients treated with long-term hemodialysis
#MMPMID23474007
Flythe JE
; Inrig JK
; Shafi T
; Chang TI
; Cape K
; Dinesh K
; Kunaparaju S
; Brunelli SM
Am J Kidney Dis
2013[Jun]; 61
(6
): 966-74
PMID23474007
show ga
BACKGROUND: Blood pressure is known to fluctuate widely during hemodialysis;
however, little is known about the association between intradialytic blood
pressure variability and outcomes. STUDY DESIGN: Retrospective observational
cohort. SETTING & PARTICIPANTS: A random sample of 6,393 adult, thrice-weekly,
in-center, maintenance hemodialysis patients dialyzing at 1,026 dialysis units
within a single large dialysis organization. PREDICTOR: Intradialytic systolic
blood pressure (SBP) variability. This was calculated using a mixed linear
effects model. Peridialytic SBP phenomena were defined as starting SBP
(regression intercept), systematic change in SBP over the course of dialysis (2
regression slopes), and random intradialytic SBP variability (absolute regression
residual). OUTCOMES: All-cause and cardiovascular mortality. MEASUREMENTS: SBPs
(n = 631,922) measured during hemodialysis treatments (n = 78,961) during the
first 30 days in the study. Outcome data were obtained from the dialysis unit
electronic medical record and were considered beginning on day 31. RESULTS: High
(ie, greater than the median) versus low SBP variability was associated with
greater risk of all-cause mortality (adjusted HR, 1.26; 95% CI, 1.08-1.47). The
association between high SBP variability and cardiovascular mortality was even
more potent (adjusted HR, 1.32; 95% CI, 1.01-1.72). A dose-response trend was
observed across quartiles of SBP variability for both all-cause (P = 0.001) and
cardiovascular (P = 0.04) mortality. LIMITATIONS: Inclusion of patients from a
single large dialysis organization, over-representation of African Americans and
patients with diabetes and heart failure, and lack of standardized SBP
measurements. CONCLUSIONS: Greater intradialytic SBP variability is associated
independently with increased all-cause and cardiovascular mortality. Further
prospective studies are needed to confirm findings and identify means of reducing
SBP variability to facilitate randomized study.