Association of Blood Pressure Increases During Hemodialysis With 2-Year Mortality in Incident Hemodialysis Patients

A Secondary Analysis of the Dialysis Morbidity and Mortality Wave 2 Study

Jula K. Inrig, Uptal D. Patel, Robert D. Toto, Lynda A. Szczech

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101 Citations (Scopus)

Abstract

Background: Intradialytic increases in blood pressure (BP) can complicate the management of hypertension in hemodialysis (HD) patients. However, the long-term consequences are uncertain. Thus, we sought to determine whether BP increases during HD were associated with greater 2-year mortality in incident HD patients. Study Design: Secondary analysis of a prospective dialysis cohort. Setting & Participants: Incident HD patients in the Dialysis Morbidity and Mortality Wave 2 Study. Predictors: Changes in systolic BP (SBP) during HD (ie, postdialysis SBP - predialysis SBP), averaged from 3 HD sessions before enrollment. Outcome: Time to 2-year all-cause mortality. Measurements: Cox regression was used to model hazard ratios for mortality associated with changes in SBP during HD while adjusting for demographics, comorbid conditions, interdialytic weight gain, laboratory variables, and antihypertensive agents. Results: Of 1,748 patients, 12.2% showed greater than 10-mm Hg increases in SBP during HD. In adjusted analyses, every 10-mm Hg increase in SBP during HD was associated independently with a 6% increased hazard of death (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.11). When also adjusted for diastolic BP and postdialysis SBP, the adjusted hazard of death associated with increasing SBP during HD remained significant (hazard ratio, 1.12; 95% confidence interval, 1.05 to 1.21 per 10-mm Hg increase in SBP during HD). However, in analyses adjusted for predialysis SBP, there was a significant interaction between change in SBP and predialysis SBP. In analyses stratified by predialysis SBP, trends for increased mortality associated with increasing SBP during dialysis were present in patients with predialysis SBP less than 160 mm Hg. However, this relationship was significant only in patients with predialysis SBP less than 120 mm Hg. Limitations: Secondary analysis with a limited number of baseline BP measurements and limited information about dialysis prescription. Conclusions: Increasing SBP by more than 10 mm Hg during HD occurs in approximately 10% of incident patients, and although increasing SBP during HD was associated with decreased 2-year survival, these findings were limited to patients with predialysis SBP less than 120 mm Hg.

Original languageEnglish (US)
Pages (from-to)881-890
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume54
Issue number5
DOIs
StatePublished - Nov 2009

Fingerprint

Renal Dialysis
Dialysis
Blood Pressure
Morbidity
Mortality
Confidence Intervals
Proportional Hazards Models
Antihypertensive Agents
Weight Gain
Prescriptions
Demography
Hypertension
Survival

Keywords

  • Blood pressure
  • end-stage renal disease
  • epidemiology and outcomes
  • hemodialysis
  • hypertension
  • mortality

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{3a06bf682dbb482d9da2b699944729a2,
title = "Association of Blood Pressure Increases During Hemodialysis With 2-Year Mortality in Incident Hemodialysis Patients: A Secondary Analysis of the Dialysis Morbidity and Mortality Wave 2 Study",
abstract = "Background: Intradialytic increases in blood pressure (BP) can complicate the management of hypertension in hemodialysis (HD) patients. However, the long-term consequences are uncertain. Thus, we sought to determine whether BP increases during HD were associated with greater 2-year mortality in incident HD patients. Study Design: Secondary analysis of a prospective dialysis cohort. Setting & Participants: Incident HD patients in the Dialysis Morbidity and Mortality Wave 2 Study. Predictors: Changes in systolic BP (SBP) during HD (ie, postdialysis SBP - predialysis SBP), averaged from 3 HD sessions before enrollment. Outcome: Time to 2-year all-cause mortality. Measurements: Cox regression was used to model hazard ratios for mortality associated with changes in SBP during HD while adjusting for demographics, comorbid conditions, interdialytic weight gain, laboratory variables, and antihypertensive agents. Results: Of 1,748 patients, 12.2{\%} showed greater than 10-mm Hg increases in SBP during HD. In adjusted analyses, every 10-mm Hg increase in SBP during HD was associated independently with a 6{\%} increased hazard of death (hazard ratio, 1.06; 95{\%} confidence interval, 1.01 to 1.11). When also adjusted for diastolic BP and postdialysis SBP, the adjusted hazard of death associated with increasing SBP during HD remained significant (hazard ratio, 1.12; 95{\%} confidence interval, 1.05 to 1.21 per 10-mm Hg increase in SBP during HD). However, in analyses adjusted for predialysis SBP, there was a significant interaction between change in SBP and predialysis SBP. In analyses stratified by predialysis SBP, trends for increased mortality associated with increasing SBP during dialysis were present in patients with predialysis SBP less than 160 mm Hg. However, this relationship was significant only in patients with predialysis SBP less than 120 mm Hg. Limitations: Secondary analysis with a limited number of baseline BP measurements and limited information about dialysis prescription. Conclusions: Increasing SBP by more than 10 mm Hg during HD occurs in approximately 10{\%} of incident patients, and although increasing SBP during HD was associated with decreased 2-year survival, these findings were limited to patients with predialysis SBP less than 120 mm Hg.",
keywords = "Blood pressure, end-stage renal disease, epidemiology and outcomes, hemodialysis, hypertension, mortality",
author = "Inrig, {Jula K.} and Patel, {Uptal D.} and Toto, {Robert D.} and Szczech, {Lynda A.}",
year = "2009",
month = "11",
doi = "10.1053/j.ajkd.2009.05.012",
language = "English (US)",
volume = "54",
pages = "881--890",
journal = "American Journal of Kidney Diseases",
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TY - JOUR

T1 - Association of Blood Pressure Increases During Hemodialysis With 2-Year Mortality in Incident Hemodialysis Patients

T2 - A Secondary Analysis of the Dialysis Morbidity and Mortality Wave 2 Study

AU - Inrig, Jula K.

AU - Patel, Uptal D.

AU - Toto, Robert D.

AU - Szczech, Lynda A.

PY - 2009/11

Y1 - 2009/11

N2 - Background: Intradialytic increases in blood pressure (BP) can complicate the management of hypertension in hemodialysis (HD) patients. However, the long-term consequences are uncertain. Thus, we sought to determine whether BP increases during HD were associated with greater 2-year mortality in incident HD patients. Study Design: Secondary analysis of a prospective dialysis cohort. Setting & Participants: Incident HD patients in the Dialysis Morbidity and Mortality Wave 2 Study. Predictors: Changes in systolic BP (SBP) during HD (ie, postdialysis SBP - predialysis SBP), averaged from 3 HD sessions before enrollment. Outcome: Time to 2-year all-cause mortality. Measurements: Cox regression was used to model hazard ratios for mortality associated with changes in SBP during HD while adjusting for demographics, comorbid conditions, interdialytic weight gain, laboratory variables, and antihypertensive agents. Results: Of 1,748 patients, 12.2% showed greater than 10-mm Hg increases in SBP during HD. In adjusted analyses, every 10-mm Hg increase in SBP during HD was associated independently with a 6% increased hazard of death (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.11). When also adjusted for diastolic BP and postdialysis SBP, the adjusted hazard of death associated with increasing SBP during HD remained significant (hazard ratio, 1.12; 95% confidence interval, 1.05 to 1.21 per 10-mm Hg increase in SBP during HD). However, in analyses adjusted for predialysis SBP, there was a significant interaction between change in SBP and predialysis SBP. In analyses stratified by predialysis SBP, trends for increased mortality associated with increasing SBP during dialysis were present in patients with predialysis SBP less than 160 mm Hg. However, this relationship was significant only in patients with predialysis SBP less than 120 mm Hg. Limitations: Secondary analysis with a limited number of baseline BP measurements and limited information about dialysis prescription. Conclusions: Increasing SBP by more than 10 mm Hg during HD occurs in approximately 10% of incident patients, and although increasing SBP during HD was associated with decreased 2-year survival, these findings were limited to patients with predialysis SBP less than 120 mm Hg.

AB - Background: Intradialytic increases in blood pressure (BP) can complicate the management of hypertension in hemodialysis (HD) patients. However, the long-term consequences are uncertain. Thus, we sought to determine whether BP increases during HD were associated with greater 2-year mortality in incident HD patients. Study Design: Secondary analysis of a prospective dialysis cohort. Setting & Participants: Incident HD patients in the Dialysis Morbidity and Mortality Wave 2 Study. Predictors: Changes in systolic BP (SBP) during HD (ie, postdialysis SBP - predialysis SBP), averaged from 3 HD sessions before enrollment. Outcome: Time to 2-year all-cause mortality. Measurements: Cox regression was used to model hazard ratios for mortality associated with changes in SBP during HD while adjusting for demographics, comorbid conditions, interdialytic weight gain, laboratory variables, and antihypertensive agents. Results: Of 1,748 patients, 12.2% showed greater than 10-mm Hg increases in SBP during HD. In adjusted analyses, every 10-mm Hg increase in SBP during HD was associated independently with a 6% increased hazard of death (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.11). When also adjusted for diastolic BP and postdialysis SBP, the adjusted hazard of death associated with increasing SBP during HD remained significant (hazard ratio, 1.12; 95% confidence interval, 1.05 to 1.21 per 10-mm Hg increase in SBP during HD). However, in analyses adjusted for predialysis SBP, there was a significant interaction between change in SBP and predialysis SBP. In analyses stratified by predialysis SBP, trends for increased mortality associated with increasing SBP during dialysis were present in patients with predialysis SBP less than 160 mm Hg. However, this relationship was significant only in patients with predialysis SBP less than 120 mm Hg. Limitations: Secondary analysis with a limited number of baseline BP measurements and limited information about dialysis prescription. Conclusions: Increasing SBP by more than 10 mm Hg during HD occurs in approximately 10% of incident patients, and although increasing SBP during HD was associated with decreased 2-year survival, these findings were limited to patients with predialysis SBP less than 120 mm Hg.

KW - Blood pressure

KW - end-stage renal disease

KW - epidemiology and outcomes

KW - hemodialysis

KW - hypertension

KW - mortality

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U2 - 10.1053/j.ajkd.2009.05.012

DO - 10.1053/j.ajkd.2009.05.012

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EP - 890

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 5

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