Kidney Week

Abstract: FR-PO354

Higher Hemodialysis Product Is Associated with Lower Systolic Blood Pressure in Home Hemodialysis Patients

Session Information

• Hypertension and CVD: Clinical, Outcomes, Trials
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States

Eric D. Weinhandl,

• Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States

Kristine Kubisiak,

• Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States

Debabrata Ray,

• Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States

Allan J. Collins,

Background

Emerging data has clarified that 24-hour ambulatory blood pressure is linearly associated with risk of cardiovascular events. Randomized clinical trials consistently show that increasing hemodialysis (HD) frequency reduces systolic blood pressure (SBP). Thus, the HD prescription may be calibrated to target blood pressure and corresponding cardiovascular risk. We assessed whether Scribner and Oreopoulous' hemodialysis product (HDP) is associated with pre-dialysis SBP in a cohort of home hemodialysis (HHD) patients.

Methods

We analyzed data from US patients who have undergone HHD with the NxStage System One and used Nx2me Connected Health. Data regarding HD frequency, session duration, and pre-dialysis SBP were organized into calendar weeks. We retained all calendar weeks with ≥3 HD sessions. For each calendar week, we calculated the HDP as equal to (mean session duration, in hours) × (number of HD sessions)². We fit generalized estimating equations to model separately the associations of pre-dialysis SBP with HDP, HD frequency, and HD hours per week, with adjustment for age and sex.

Results

We analyzed data from 769 patients, 34,340 calendar weeks, and 142,210 HD sessions. Mean age was 54.3 years; 66.4% of calendar weeks were accumulated in male patients. Mean treatment frequency was 4.1 sessions per week, mean (standard deviation) HDP was 56 (28) points, and mean HDP with 3, 4, 5, 6, and 7 sessions was 32, 52, 75, 97, and 122 points, respectively. Mean (standard deviation) pre-dialysis SBP was 135.1 (22.6) mmHg. In a multivariate model, each 10-point increment in the HDP was associated with a 1.5-mmHg decrement (95% confidence interval, 1.1-2.0) in pre-dialysis SBP. Each 5-year increment in age was associated with a 0.4-mmHg increment in pre-dialysis SBP (P = 0.25), and male versus female sex was associated with a 4.8-mmHg increment (P = 0.004). Goodness of fit was best with HDP, moderate with HD frequency, and worst with HD hours per week.

Conclusion

The HDP is a simple-to-use formula that be used to calibrate both treatment frequency and session duration to target a specific change in pre-dialysis SBP. Increased HDP is associated with decreased pre-dialysis SBP, implying that schedules of 3 sessions/week × 3.5 hours/session and 6 sessions/week × 8 hours/sessions are associated with highest and lowest SBP, respectively.

Funding

• Commercial Support –