Journal of Human Hypertension

Changes in pre-dialysis blood pressure variability in the first year of dialysis associate with mortality in European hemodialysis patients

Marijke J. E. Dekker, Len Usvyat, Constantijn J. A. M. Konings, Jeroen P. Kooman, Bernard Canaud, Paola Carioni, Daniele Marcelli, Frank M. van der Sande, Vaibhav Maheshwari, Yuedong Wang, Peter Kotanko, Jochen G Raimann

Pre-hemodialysis systolic blood pressure variability (pre-HD SBPV) has been associated with outcomes. The association of a change in pre-HD SBPV over time with outcomes, and predictors of this change, has not yet been studied. Therefore, we studied this in a cohort of 8825 incident hemodialysis (HD) patients from the European Monitoring Dialysis Outcomes Initiative database. Patient level pre-HD SBPV was calculated as the standard deviation of the residuals of a linear regression model of systolic blood pressure (SBP) over time divided by individual mean SBP in the respective time periods. The pre-HD SBPV difference between months 1–6 and 7–12 was used as an indicator of pre-HD SBPV change. The association between pre-HD SBPV change and all-cause mortality in year 2 was analyzed by multivariate Cox models. Predictors of pre-HD SBPV change was determined by logistic regression models. We found the highest pre-HD SBPV tertile, in the first 6 months after initiation of HD, had the highest mortality rates (adjusted HR 1.44 (95% confidence intervals (95% CI): 1.15–1.79)). An increase in pre-HD SBPV between months 1–6 and 7–12 was associated with an increased risk of mortality in year 2 (adjusted HR 1.29 (95% CI: 1.05–1.58)) compared with stable pre-HD SPBV. A pre-HD SBPV increase was associated with female gender, higher mean pre-HD SBP and pulse pressure, and lower HD frequency.

About the Contributors

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as Vice Chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked 1982-89 at the Department of Physiology and the University Clinic of Internal Medicine, Innsbruck, Austria...

Jochen G. Raimann, MD, PhD, MPH

Senior Manager, Clinical Data Analytics

Dr. Raimann has worked as a full-time scientist at the Renal Research Institute since his start as a post-doctoral Research Fellow in 2007. Currently as the Senior Manager of Clinical Data Analytics, Dr. Raimann conducts epidemiological research in dialysis and oversees many analytical projects. He has first- and co-authored numerous also serves as Associate Editor of the journals ‘Trials’ and “Scientific Reports”...