Kidney Week

Abstract: FR-PO842

Effects of Blood Pressure Variability on Mortality in Chronic Hemodialysis Patients: OCTOPUS Study

Session Information

• Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular - I
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

• Adachi, Takayuki, Tomishiro Central Hospital, Tomigusuku city, Japan

Takayuki Adachi,

• Kohagura, Kentaro, University of the Ryukyus, Nishihara-cho, OKINAWA, Japan

Kentaro Kohagura,

• Arima, Hisatomi, Fukuoka Uniuversity, Fukuoka, Japan

Hisatomi Arima,

• Iseki, Kunitoshi, Tomishiro Central Hospital, Tomigusuku city, Japan

Kunitoshi Iseki,

Background

We examined the relationship between blood pressure variability and survival among chronic HD patients.

Methods

We previously reported the results of the multi-center prospective, open trial of the Olmesartan Clinical Trial in Okinawa Patients Under Okinawa Dialysis Study (OCTOPUS). In a multicenter, prospective, randomized, open label, blinded-endpoint trial, 469 patients with chronic HD and elevated BP (140–199/90–99 mmHg) were assigned to receive the angiotensin receptor blockade (ARB) olmesartan (at a dose of 10–40 mg daily; n = 235) or another treatment that does not include angiotensin receptor blockers and angiotensin-converting enzyme (ACE) inhibitors (n = 234).
For this study, we examined of 435 patients after excluding those who died within 1 year after registration (N=28) and lack of blood pressure data for more than 2 time (N=6). We adopted the coefficient of variation (CV), which was obtained using 6 pre-HD blood pressure within the first year after registration, as a marker of blood pressure variability. Cox proportional hazard analysis was used to examine the relationship between blood pressure variability and mortality after the 1-year visit with adjustment for age, sex, smoking, DM, HD vintage, and use of angiotensin receptor blockade.

Results

During the mean follow-up of 2.5 years after the 1-year visit, we observed 58 deaths. We used five quintile groups of CV pre-HD systolic blood pressure (Q1 to Q5). The mortality rate was 9.2% (Q1), 12.8% (Q2), 9.1% (Q3), 16.1% (Q4), and 19.5% (Q5), respectively. The adjusted hazard ratio (95% confidence interval) was 1.83 (0.73-4.63) in Q1, 1.83 (0.73-4.63) in Q2, 1.84 (0.77-4.40) in Q4, and 2.42 (1.04-5.62) in Q5 when the Q3 was taken as reference.

Conclusion

Mortality rate was higher among patients with higher pre-HD variability of blood pressure.