Blood Pressure Variability Is Associated With Outcome In Patients Treated With Maintaince Hemodialysis

Background:Hypertension is highly prevalent in hemodialysis patients,occurring in over 90%of patients,but optimal strategies for management of hypertension in these patients remain unclear.The factors associated with intradialytic blood pressure variability(BPV)have recently been described,but the factors associated with predialysis.BPV and its association with clinical outcomes are not well understood.Objective:To investigate the assoctiations between BPV and prognosis in maintenance hemodialysis patients(MHD).Methodology:Patients with end stage renal disease on MHD before July 1.2014 were enrolled and analyzed retrospectively.Blood pressure at the first hemodialysis every month during July,2014 and June,2016 were recorded.The Predialysis systolic pressure,diastolic pressure,intradialytic systolic pressure,diastolic pressure per hour and postdialysis systolic pressure,diastolic pressure were calculated,and dialysis systolic and diastolic BPV were expressed with discrete coefficients.As for patients with follow—up time less than 2 years.blood pressures in evenly distributed 20—24 courses were used for calculation.Cardiovascular death and death from any cause were recorded.Patients were assigned into 4 groups according to the BPV by a quartile method,and clinical characteristics were then compared among the 4 groups.The association of every BPV to mortality were identified with a multivariate COX hazard model.Result:A total of 265 adult hemodialysis Patients were enrolled in the study.enrolled.the average Predialysis systolic BP of 144.5±16.8 mmHg?diastolic BP of 76.0±10.0mmHg,the average intradialytic systolic BP of 140.1 ± 16.8 mmHg?systolic BP of 75.8±9.5 mmHg,the average postdialysis systolic BP of 139.7±13.8 mmHg?systolic BP of 75.8±7.9 mmHg,the BP absolute value is not a risk factor of mortality in the univariate COX regression analysis(p>0.05).with Predialysis systolic BPV of 0.115±0.07,Predialysis diastolic BPV of 0.128±0.114,intradialytic systolic BPV of 0.120±0.046,intradialytic diastolic BPV of 0.127±0.084,postdialysis systolic BPV of 0.099±0.084,postdialysis diastolic BPV of 0.105±0.029.High Predialysis systolic BPV(>0.129)versus low SBP variability was associated with a greater risk of cardiovascular mortality(p<0.05).The association between high SBP variability and all-cause mortality was even more potent.In the univariate COX regression analysis,higher Predialysis systolic BPV is a risk factor of cardiovascular mortality and all-cause mortality(P=0.021).In the COX proportional hazards model after adjustment for multi-factors,Predialysis systolic BPV remained an independent factor of all-cause mortality in hemodialysis Patients.There is no association between Predialysis diastolic BPV?intradialytic systolic BPV?intradialytic diastolic BPV?postdialysis systolic BPV?diastolic pressure BPV and cardiovascular mortality?all-cause mortality(P>0.05).Conclusion:the BP absolute value is not a risk factor of mortality,Predialysis systolic BPV is an independent risk factor for cardiovascular mortality,and a potentially modifiable risk factor for outcomes in incident hemodialysis patients.