Abstract: SA-PO778

The Association Between Tobacco Use and Intradialytic Hemodynamics in Hemodialysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Sonderman, Mark T., UT Southwestern Medical Center, Dallas, Texas, United States
  • Van Buren, Peter N., UT Southwestern Medical Center, Dallas, Texas, United States
Background

Extreme changes in intradialytic blood pressure are associated with poor outcomes in hemodialysis patients, but the overall effect of traditional cardiovascular risk factors on these outcomes is poorly understood. We sought to explore the effect of lifetime tobacco use on vascular hemodynamics during dialysis.

Methods

We determined smoking status among a group of hypertensive hemodialysis (HD) patients concurrently enrolled in a cross-sectional study. We compared differences in pre, post, and intradialytic change in systolic blood pressure (SBP), total peripheral resistance index (TPRI), and cardiac index (CI) in subjects defined as never smokers or smokers (current or former) using unpaired t-tests and multivariable linear regression controlling for ultrafiltration rate, diabetes, baseline hemodynamics, and other baseline characteristics.

Results

The pre and post dialysis hemodynamics are shown in Table 1. The ΔTPRI was -582 dynes/sec/cm2/m2 in smokers and 102 dynes/sec/cm2/m2 in non-smokers (p-value = 0.003). The ΔCI was 0.249 L/min/m2 in smokers and -0.063 L/min/m2 in non-smokers (p-value = 0.02). The ΔSBP was -14.5 mmHg in smokers and -10.3 mmHg in non-smokers (p-value = 0.63). In multivariable linear regression, there was an independent association between smoking and ΔTPRI (p=0.012) with an average reduction of 522 dynes/sec/cm2/m2 in ΔTPRI in HD patients with a history of tobacco use.

Conclusion

Hemodialysis patients with a smoking history have reductions in intradialytic TPRI compared to non-smokers although overall BP changes were not different. Further research needs to be done to identify the role of smoking and smoking cessation on intradialytic hemodynamics.

Hemodynamic Values Before and After Dialysis
 SmokersNever Smokers 
VariablePrePostDeltaPrePostDeltap-value
SBP153 (21.0)139 (23.0)-14.5 (29.1)158 (17.7)147 (21.7)-10.3 (31.5)0.63
TPRI3320 (972)2740 (640)-582 (799)2920 (703)3030 (1010)102 (834)0.003
Cardiac Index2.91 (0.647)3.16 (0.521)0.249 (0.459)3.05 (0.577)2.99 (0.702)-0.063 (0.486)0.02

The p-value compares the delta between the two groups.

The data are presented as box plots which indicate the 5th, 25th, 50th, 75th, and 95th percentiles.

Funding

  • NIDDK Support