Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients

J. K. Inrig, E. Z. Oddone, V. Hasselblad, Barbara Gillespie, U. D. Patel, D. Reddan, R. Toto, J. Himmelfarb, J. F. Winchester, J. Stivelman, R. M. Lindsay, L. A. Szczech

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114 Citations (Scopus)

Abstract

The relationship between blood pressure (BP) and clinical outcomes among hemodialysis patients is complex and incompletely understood. This study sought to assess the relationship between blood pressure changes with hemodialysis and clinical outcomes during a 6-month period. This study is a secondary analysis of the Crit-Line Intradialytic Monitoring Benefit Study, a randomized trial of 443 hemodialysis subjects, designed to determine whether blood volume monitoring reduced hospitalization. Logistic regression was used to estimate the association between BP changes with hemodialysis (Δsystolic blood pressure=postdialysis-predialysis systoic BP (SBP) and the primary outcome of non-access-related hospitalization and death. Subjects whose systolic blood pressure fell with dialysis were younger, took fewer blood pressure medications, had higher serum creatinine, and higher dry weights. After controlling for baseline characteristics, lab variables, and treatment group, subjects whose SBP remained unchanged with hemodialysis (N=150, ΔSBP -10 to 10 mm Hg) or whose SBP rose with hemodialysis (N=58, ΔSBP ≥10 mm Hg) had a higher odds of hospitalization or death compared to subjects whose SBP fell with hemodialysis (N=230, ΔSBP ≤-10 mm Hg) (odds ratio: 1.85, confidence interval: 1.15-2.98; and odds ratio: 2.17, confidence interval: 1.13-4.15). Subjects whose systolic blood pressure fell with hemodialysis had a significantly decreased risk of hospitalization or death at 6 months, suggesting that hemodynamic responses to dialysis are associated with short-term outcomes among a group of prevalent hemodialysis subjects. Further research should attempt to elucidate the mechanisms behind these findings.

Original languageEnglish (US)
Pages (from-to)454-461
Number of pages8
JournalKidney International
Volume71
Issue number5
DOIs
StatePublished - Mar 2007

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Chronic Kidney Failure
Hospitalization
Renal Dialysis
Blood Pressure
Mortality
Dialysis
Odds Ratio
Confidence Intervals
Blood Volume
Creatinine
Logistic Models
Hemodynamics
Weights and Measures
Serum

Keywords

  • Blood pressure
  • Epidemiology and outcomes
  • ESRD
  • Hemodialysis
  • Hypertension

ASJC Scopus subject areas

  • Nephrology

Cite this

Inrig, J. K., Oddone, E. Z., Hasselblad, V., Gillespie, B., Patel, U. D., Reddan, D., ... Szczech, L. A. (2007). Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients. Kidney International, 71(5), 454-461. https://doi.org/10.1038/sj.ki.5002077

Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients. / Inrig, J. K.; Oddone, E. Z.; Hasselblad, V.; Gillespie, Barbara; Patel, U. D.; Reddan, D.; Toto, R.; Himmelfarb, J.; Winchester, J. F.; Stivelman, J.; Lindsay, R. M.; Szczech, L. A.

In: Kidney International, Vol. 71, No. 5, 03.2007, p. 454-461.

Research output: Contribution to journalArticle

Inrig, JK, Oddone, EZ, Hasselblad, V, Gillespie, B, Patel, UD, Reddan, D, Toto, R, Himmelfarb, J, Winchester, JF, Stivelman, J, Lindsay, RM & Szczech, LA 2007, 'Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients', Kidney International, vol. 71, no. 5, pp. 454-461. https://doi.org/10.1038/sj.ki.5002077
Inrig, J. K. ; Oddone, E. Z. ; Hasselblad, V. ; Gillespie, Barbara ; Patel, U. D. ; Reddan, D. ; Toto, R. ; Himmelfarb, J. ; Winchester, J. F. ; Stivelman, J. ; Lindsay, R. M. ; Szczech, L. A. / Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients. In: Kidney International. 2007 ; Vol. 71, No. 5. pp. 454-461.
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