Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes

Jula K. Inrig, Uptal D. Patel, Robert D. Toto, Donal N. Reddan, Jonathan Himmelfarb, Robert M. Lindsay, John Stivelman, James F. Winchester, Lynda A. Szczech

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Pulse pressure is a well established marker of vascular stiffness and is associated with increased mortality in hemodialysis patients. Here we sought to determine if a decrease in pulse pressure during hemodialysis was associated with improved outcomes using data from 438 hemodialysis patients enrolled in the 6-month Crit-Line Intradialytic Monitoring Benefit Study. The relationship between changes in pulse pressure during dialysis (2-week average) and the primary end point of non-access-related hospitalization and death were adjusted for demographics, comorbidities, medications, and laboratory variables. In the analyses that included both pre-and post-dialysis pulse pressure, higher pre-dialysis and lower post-dialysis pulse pressure were associated with a decreased hazard of the primary end point. Further, every 10 mm Hg decrease in pulse pressure during dialysis was associated with a 20% lower hazard of the primary end point. In separate models that included pulse pressure and the change in pulse pressure during dialysis, neither pre-nor post-dialysis pulse pressure were associated with the primary end point, but each 10 mm Hg decrease in pulse pressure during dialysis was associated with about a 20% lower hazard of the primary end point. Our study found that in prevalent dialysis subjects, a decrease in pulse pressure during dialysis was associated with improved outcomes. Further study is needed to identify how to control pulse pressure to improve outcomes.

Original languageEnglish (US)
Pages (from-to)1098-1107
Number of pages10
JournalKidney international
Volume76
Issue number10
DOIs
StatePublished - Nov 1 2009

Keywords

  • End-stage renal disease
  • Hemodialysis
  • Intradialytic blood pressure
  • Morbidity and mortality
  • Outcomes
  • Pulse pressure

ASJC Scopus subject areas

  • Nephrology

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    Inrig, J. K., Patel, U. D., Toto, R. D., Reddan, D. N., Himmelfarb, J., Lindsay, R. M., Stivelman, J., Winchester, J. F., & Szczech, L. A. (2009). Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes. Kidney international, 76(10), 1098-1107. https://doi.org/10.1038/ki.2009.340