Kidney Week

Abstract: TH-OR114

The HOME-BP Trial: Treating Home vs. Predialysis Blood Pressure in Patients on Hemodialysis

Session Information

• Late-Breaking Research Orals: Dialysis and Transplantation
  October 22, 2026 | Location: Four Seasons Ballroom 2, Convention Center
  Abstract Time: 04:54 PM - 05:06 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Bansal, Nisha, University of Washington, Seattle, Washington, United States

Nisha Bansal, MD, FASN

• Heagerty, Patrick James, University of Washington, Seattle, Washington, United States

Patrick James Heagerty, MS, PhD

• Comstock, Bryan A., University of Washington, Seattle, Washington, United States

Bryan A. Comstock, MSc

• Schmicker, Robert, University of Washington, Seattle, Washington, United States

Robert Schmicker, MS

• Rivara, Matthew B., University of Washington, Seattle, Washington, United States

Matthew B. Rivara, MD, FASN

• Cohen, Jordana B., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Jordana B. Cohen, MD, MS, FASN

• Sarathy, Harini, University of California San Francisco, San Francisco, California, United States

Harini Sarathy, MBBS, MS

• Mehrotra, Rajnish, University of Washington, Seattle, Washington, United States

Rajnish Mehrotra, MD, MS, FASN

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu, MD, MSc, FASN

Background

Treatment targets for hypertension in hemodialysis patients are unknown. Observational data show a U-shaped association between pre-dialysis systolic blood pressure (SBP) and adverse outcomes; but a stepwise linear relationship between higher out of dialysis unit SBP (e.g. home BP) and higher risk of these outcomes. The HOME-BP trial (NCT05159999) was the first multi-center trial to determine the efficacy of treating home SBP <140mmHg vs. pre-dialysis SBP<140 mmHg.

Methods

This was a 10-month, pragmatic cross-over RCT of 200 hemodialysis participants testing a strategy to treat home SBP <140 mmHg vs. pre-dialysis SBP<140 mmHg. Participants were randomized to either treatment of home vs. pre-dialysis SBP for the initial 5-month period and then crossed-over to the alternative treatment strategy for the 2^nd 5-month period (with blinding to SBP readings not being targeted). Participants measured their home BP twice a week (three measurements per sitting) on a non-dialysis day for the entire trial. Pre-dialysis BPs were obtained as part of clinical care. Target SBP for both treatment strategies was achieved using volume management and anti-hypertensive medications. The primary outcome was rate of intradialytic hypotension (IDH), defined as the percent of dialysis sessions with at least one intradialytic SBP<90mmHg.

Results

The median age of the study population was 58 (IQR 47-65) years and 73% were male. At baseline, mean (SD) home SBP was 143.6 (20.6) and mean pre-dialysis SBP was 147.6 (16.6) (r = 0.68). Pre-dialysis SBP was higher than home BP in on average (median 4.0 [(IQR -5.0, 15.5]mmHg) but home BP was higher 37% of the time. Trends of SBP are shown in Figure 1. Rates of IDH did not differ by targeting home (6.6%) vs. pre-dialysis SBP (6.3%) (aRR [95% CI] = 0.99 [0.82 – 1.20]). Rates of serious adverse events were similar with both treatment strategies.

Conclusion

In this pragmatic cross-over RCT, targeting home SBP < 140 mmHg did not reduce rates of IDH compared with targeting pre-dialysis SBP <140 mmHg.

Funding

• NIDDK Support