Kidney Week

Abstract: TH-OR005

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

Session Information

• Cardiovascular Outcomes in Hemodialysis
  November 02, 2017 | Location: Room 277, Morial Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Dialysis

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

Authors

• Assimon, Magdalene M., University of North Carolina, Chapel Hill, North Carolina, United States

Magdalene M. Assimon, PharmD



Dr. Assimon is a currently a post-doctoral trainee at the University of North Carolina Kidney Center mentored by Dr. Jennifer Flythe. Magdalene received her PharmD degree from Albany College of Pharmacy and also completed her Nephrology Pharmacotherapy Fellowship there. Earlier this fall she successfully defended her doctoral dissertation and will receive a PhD degree in Epidemiology from the University of North Carolina Gillings School of Global Public Health. Magdalene is interested in determining how to best leverage administrative and electronic medical record data to answer important clinical questions that will ultimately influence dialysis patient care. In particular, her research focuses on: 1) evaluating the safety and efficacy of medications in the dialysis population, and 2) understanding role of dialysis treatment-related factors in the pathogenesis of cardiovascular morbidity and mortality among hemodialysis patients.

• Flythe, Jennifer E., University of North Carolina, Chapel Hill, North Carolina, United States

Jennifer E. Flythe,

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