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Abstract: TH-PO213

Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systemic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Zhao, Yuliang, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  • Yang, Letian, West China Hospital of Sichuan University, Chengdu, Sichuan, China
  • Fu, Ping, West China Hospital of Sichuan University, Chengdu, SICHUAN, China
Background


As the prognostic value of blood pressure variability (BPV) in hemodialysis patients had previously been inconclusive, this work performed a systematic review and meta-analysis to assess the association between BPV and clinical outcomes in the hemodialysis population.

Methods


Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched through March 5, 2019 for full text articles in English. Cohort studies on the association between BPV and prognosis in hemodialysis patients were selected. Study selection and data extraction were performed by two reviewers independently, with adjudication by a third reviewer. Hazard ratios and 95% confidence interval were pooled in a random-effects model for the primary outcomes of all-cause and cardiovascular mortality. Statistical analysis was performed using STATA 14.0 (STATA Corp., Texas, USA).

Results


A total of 13 studies (37,827 patients) were eligible. Systolic BPV was associated with higher all-cause mortality (HR: 1.12, 95% CI: 1.06-1.19, P < 0.001) and cardiovascular mortality (HR: 1.16, 95% CI: 1.10-1.22, P<0.001), while diastolic BPV was not associated with them (P = 0.14, 0.56). Long-term systolic BPV (inter-dialytic or inter-visit BPV) was shown to be a risk factor for all-cause (HR: 1.11, 95% CI: 1.05-1.17, P = 0.001) and cardiovascular (HR: 1.14, 95% CI: 1.06-1.22, P<0.001) mortality, but short-term systolic BPV (intra-dialytic or ambulatory) was only associated with cardiovascular mortality (HR: 1.19, 95% CI: 1.09-1.29, P < 0.001). The associations between systolic BPV and mortality events were not affected by region (North America-Europe vs. Asia), follow-up time (≤2.5 years vs. >2.5 years) or variable type (BPV as a categorical vs. continuous variable). Among the different BPV metrics, the coefficient of variation (CV) of systolic blood pressure was identified as predictor of both all-cause (P=0.012) and cardiovascular (P=0.002) death.

Conclusion


In the hemodialysis population, systolic BPV was associated with both increased all-cause and cardiovascular mortality, while diastolic BPV was not associated with the clinical outcomes. CV of systolic blood pressure was identified as a predictor for both all-cause and cardiovascular mortality, while the utility of other BPV metrics requires further investigation.

Funding

  • Government Support - Non-U.S.