Abstract: TH-OR005

Intradialytic Hypertension Frequency and Short-Term Clinical Outcomes among Hemodialysis Patients

Session Information

Category: Dialysis

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

Authors

  • Assimon, Magdalene M., University of North Carolina, Chapel Hill, North Carolina, United States
  • Flythe, Jennifer E., University of North Carolina, Chapel Hill, North Carolina, United States
Background

Intradialytic hypertension (ID-HTN) occurs in 5-20% of hemodialysis treatments. Observational data support an association between ID-HTN and increased long-term mortality. However, the short-term cardiovascular (CV) consequences of recurrent ID-HTN are unknown.

Methods

Data were taken from a cohort of prevalent hemodialysis patients receiving treatment at a large U.S. dialysis organization on 01/01/2010. Using a retrospective cohort design with a 180-day baseline, 30-day exposure assessment and 30-day follow-up period, we estimated the association between ID-HTN frequency and: 1) 30-day mortality and 2) 30-day hospitalizations. We defined ID-HTN frequency during the 30-day exposure period as the proportion of hemodialysis treatments with a pre- to post-dialysis systolic blood pressure (BP) rise >0 mmHg. Multivariable Cox proportional hazards models, adjusting for numerous clinical, laboratory and dialysis treatment covariates, were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

Of 37,094 study patients, 5,242 (14%), 17,965 (48%), 10,821 (29%), 3,066 (8%) had ID-HTN in 0%, 1-32%, 33-66% and ≥67% of exposure period treatments, respectively. More frequent ID-HTN was associated with incremental increases in 30-day mortality and volume overload hospitalizations (Figure). Patients with ID-HTN in ≥67% (vs. 0%) of exposure period treatments had the highest risk of all-cause death, adjusted HR [95% CI]: 2.6 [1.7-3.9]; CV death, 3.7 [1.9-7.1]; and volume overload hospitalizations, 2.3 [1.3-4.2]. Analogous incremental associations were observed for all-cause and CV hospitalizations. In sensitivity analyses, use of alternative BP thresholds (≥5 and ≥10 mmHg) to define ID-HTN yielded similar results (data not shown).

Conclusion

Among prevalent hemodialysis patients, ID-HTN frequency is incrementally associated with short-term morbidity and mortality. Randomized trials are needed to determine if ID-HTN frequency mitigation improves patient outcomes.

Funding

  • NIDDK Support