The Relationship Between Survival Rate And Intradialytic Blood Pressure Changes In Hemodialysis Patients

Objective: we conducted a retrospective cohort study to explore the prognostic value of intradialytic blood pressure variability in maintenance hemodialysis patients.Methods: a retrospective study was conducted on maintenance dialysis patients in the Hemodialysis Center of the first affiliated Hospital of Nanchang University from January 2015 to December 2018.Record the patient’s blood pressure data during each hemodialysis process within one month,including before dialysis,every hour during dialysis,and after dialysis.the changes of systolic blood pressure(ΔSBP),mean arterial pressure(Δ MBP)and Mean true variability of systolic blood pressure during dialysis(SBP-ARV)were calculated Representin intradialytic blood pressure variability.The baseline data and death outcomes of the patients were collected,and the follow-up time was until December 30,2021.patients were divided into 4 groups according to the BPV by quartile method.The cumulative incidence of cardiovascular events and all-cause death in each quartile of BPV was calculated by Kaplan-Meier curve,Cox regression model to analyze the effect of different intradialysis BPV indexes on cardiovascular death and all-cause mortality in maintenance hemodialysis patients.Results: A total of 244 patients were included in the study,with an average age of 64.8 ±14.49 years and an average dialysis time of 46.50(30.25,59.00)months.Kaplan-Meier analysis showed that all-cause mortality and cardiovascular mortality were significantly increased in Δ SBP <-5.6mm Hg group and Δ SBP ≥6.34 mm Hg group(P=0.001,P =0.014).Kaplan-Meier analysis showed that All-cause mortality and cardiovascular mortality increased significantly in patients with high levels of SBP-ARV(> 8.68)(P<0.001、P=0.016).Univariate and multivariate COX regression analysis showed that: high absolute value of ΔSBP(ΔSBP<-5.6mm Hg orΔSBP≥6.34 mm Hg),higher SBP-ARV was an independent risk factor for cardiovascular death and all-cause death(P < 0.05).There was no significant difference in all-cause mortality and cardiovascular mortality in patients with different levels of ΔMAP(P>0.05).ΔMBP was not an independent risk factor for cardiovascular and all-cause mortality.Conclusion: ΔSBP<-5.6mm Hg or ΔSBP≥6.34 mm Hg,SBP-ARV>8.68 were independent risk factors for cardiovascular death and all-cause death in maintenance hemodialysis patients,while ΔMBP was not an independent risk factor for cardiovascular and all-cause death.Blood pressure changes during dialysis have predictive value for the prognosis of maintenance hemodialysis patients.