Kidney Week

Abstract: TH-OR007

Association of Peridialytic Systolic Blood Pressure Change and Pre-Dialysis Systolic Blood Pressures on Mortality among Hemodialysis Patients

Session Information

• Cardiovascular Outcomes in Hemodialysis
  November 02, 2017 | Location: Room 277, Morial Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Zhang, Hanjie, Renal Research Institute, New York, New York, United States

Hanjie Zhang



http://renalresearch.com/

• Preciado, Priscila, Renal Research Institute, New York, New York, United States

Priscila Preciado,

• Wang, Yuedong, University of California - Santa Barbara, Santa Barbara, California, United States

Yuedong Wang,

• Meyring-Wosten, Anna, Renal Research Institute, New York, New York, United States

Anna Meyring-Wosten,

• Topping, Alice, Renal Research Institute, New York, New York, United States

Alice Topping,

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann,

• Kooman, Jeroen, Maastricht University Medical Centre, Maastricht, Netherlands

Jeroen Kooman,

• van der Sande, Frank, Maastricht University Medical Centre , Maastricht, Netherlands

Frank van der Sande,

• Usvyat, Len A., Fresenius Medical Care North America, Melrose, Massachusetts, United States

Len A. Usvyat,

• Maddux, Dugan, Fresenius Medical Care North America, Melrose, Massachusetts, United States

Dugan Maddux,

• Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States

Franklin W. Maddux,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

Background

Pre-dialysis systolic blood pressure (pre-SBP) and peridialytic SBP change (ΔSBP) had been associated with mortality in former studies, but the nature of this interaction is still not fully explained.

Methods

Pre-SBP and ΔSBP (post-HD – pre-HD) were analyzed between 1/2001 and 12/2012 in HD patients treated in Fresenius Medical Care (FMC) facilities. Baseline was defined as months 4-6 in the first year of HD, the primary outcome was all-cause mortality. Censoring events were renal transplantation, modality change, or study end. Only patients who survived the baseline and had no missing covariates were included. We fitted Cox proportional hazard model with a bivariate spline for the primary predictors, pre-SBP and ΔSBP, with adjustment for age, gender, race, diabetes, access-type, relative interdialytic weight gain (IDWG), body mass index (BMI) and albumin, enPCR, and ultrafiltration rate (≥13 or <13 mL/kg body weight/hour).

Results

A total of 191 491 patients were included. We found that a peridialytic SBP increase in the presence of high pre-SBP was associated with an increased mortality, while in patients with low pre-SBP a peridialytic SBP increase was associated with better survival (Fig. 1).

Conclusion

We showed association of pre-SBP and peridialytic SBP changes with all-cause mortality in a large and diverse HD population. Patients with low pre-SBP may benefit from an increase in peridialytic SBP, while an increase in SBP may be detrimental in patients with a high pre-SBP.

Figure 1: Contour plot showing the relationship between pre-SBP, ΔSBP and hazard ratios (HR) for all-cause mortality. Contour lines indicate discrete HR levels.

Funding

• Commercial Support – Fresenius Medical Care