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Abstract: PO0878

Association of Different Definitions of Intradialytic Hypertension with Long-Term Mortality in Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Singh, Anika T., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Hypertension is common in patients receiving maintenance hemodialysis (HD). A subset of patients experience increases in systolic blood pressure (SBP) from pre- to post-HD (intradialytic hypertension). This phenomenon is known to be associated with adverse short and long-term outcomes, but there is little consensus on an evidence-based definition.

Methods

In a retrospective cohort of 3,198 HD participants, unadjusted and adjusted Cox proportional hazards models were fit to examine the association of various definitions of intradialytic hypertension (≥30% of baseline sessions with an increase in pre- to post-HD SBP of 1) ≥0 mmHg [Hyper0]; 2) ≥10 mmHg [Hyper10], or 3) ≥20 mmHg increase [Hyper20]) with all-cause mortality. Interaction terms were used to assess for effect modification according to pre-specified demographic (age, sex), HD-related (pre-HD SBP, ultrafiltration rate), and comorbid disease variables (diabetes, heart failure, and peripheral vascular disease [PVD]).

Results

At baseline, mean age was 62 ±15 years, 57% were male, and 14% were Black. Average change in BP from pre- to post-HD was 13 ±16 mmHg (median 12 [3 to 22] mmHg). During the baseline period, 47% of individuals met the Hyper0 definition and were at a 29% (HR 1.29; 95%CI 1.03 to 1.62) higher adjusted risk of death, compared with participants with no SBP increase. Hyper10 was present in 21.2% and associated with a 21% higher adjusted risk of death (HR 1.21; 95%CI 0.96 to 1.51). Hyper20 was present in 6.8% and associated with a 5% higher risk of death (HR 1.05; 95%CI 0.76 to 1.46). There was evidence for effect modification by age and PVD (P-interaction=0.02 for both), with a higher risk of death in those aged 45-70 years and those without PVD.

Conclusion

Individuals with any increase in SBP from pre- to post-HD experienced the highest adjusted risk of mortality, compared with other threshold-based definitions with effect modification by age and PVD.

Funding

  • NIDDK Support