Abstract: FR-PO844

Peridialysis BP Levels and Risk of All-Cause Mortality: A Meta-Analysis

Session Information

Category: Dialysis

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

Author

  • Han, Yu-Chen, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
Background

Blood pressure (BP) management posed great challenge in hemodialysis (HD) population. The optimal peridialysis BP for HD population was unknown. We conducted a dose-response meta-analysis to investigate the quantitative features and the potential threshold effect of the associations between peridialysis BP levels and all-cause mortality risk in HD population.

Methods

We searched all of the prospective cohort studies (published before March 18, 2017) on the associations between peridialysis BP levels and all-cause mortality risk.

Results

A total of 229,688 prevalent HD patients from 8 studies were included. The non-linear associations were noted between peridialytic BP levels and all-cause mortality risk. Significant increased risk of death was found in four peridialysis BP ranges, that is, low levels of predialysis SBP (<135mmHg, 140mmHg as the reference), two extremes of predialysis DBP (<55 and >95mmHg, 90mmHg as the reference), high levels of postdialysis SBP (>180mmHg, 130mmHg as the reference), and low levels of postdialysis DBP (<75mmHg, 80mmHg as the reference). The peridialysis BP ranges with the peak survival were 160-165mmHg for predialysis SBP, 80-85mmHg for predialysis DBP, 135-140mmHg for postdialysis SBP and 80-85mmHg for postdialysis DBP. Threshold effect was determined in the associations between peridialysis BP and all-cause mortality risk, and potential BP thresholds were identified (149mmHg for predialysis SBP, 79mmHg for predialysis DBP, 147mmHg for postdialysis SBP and 76mmHg for postdialysis DBP).

Conclusion

The optimal peridialysis BP for HD population was unknown. By incorporating major hemodialysis databases in the world, major quantitative features of the peridialysis mortality associations were explicitly identified in our study. The proposed peridialysis BP ranges and the threshold values could help clinicians identify high risk patients and give guidance to BP-lowering therapy (dry weight probing and antihypertensive drugs) in HD population.

RCS, restricted cubic spline

Funding

  • Government Support - Non-U.S.