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Predialysis systolic BP variability and outcomes in hemodialysis patients.

Publication ,  Journal Article
Shafi, T; Sozio, SM; Bandeen-Roche, KJ; Ephraim, PL; Luly, JR; St Peter, WL; McDermott, A; Scialla, JJ; Crews, DC; Tangri, N; Miskulin, DC ...
Published in: J Am Soc Nephrol
April 2014

BP variability (BPV) is an important predictor of outcomes in the general population, but its association with clinical outcomes in hemodialysis patients is not clear. We identified 11,291 patients starting dialysis in 2003-2008 and followed them through December 31, 2008 (median=22 months). Predialysis systolic BPV was assessed over monthly intervals. Outcomes included factors associated with BPV, mortality (all-cause and cardiovascular), and first cardiovascular event (cardiovascular death or hospitalization). Patients' mean age was 62 years, 55% of patients were men, and 58% of patients were white. Modifiable factors associated with higher BPV included obesity, higher calcium-phosphate product levels, and lower hemoglobin concentration; factors associated with lower BPV included greater fluid removal, achievement of prescribed dry weight during dialysis, higher hemoglobin concentration, and antihypertensive regimens without β-blockers or renin-angiotensin system blocking agents. In total, 3200 deaths occurred, including 1592 cardiovascular deaths. After adjustment for demographics, comorbidities, and clinical factors, higher predialysis BPV was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.18; 95% confidence interval [95% CI] per 1 SD increase in BPV, 1.13 to 1.22), cardiovascular mortality (HR, 1.18; 95% CI, 1.12 to 1.24), and first cardiovascular event (HR, 1.11; 95% CI, 1.07 to 1.15). Results were similar when BPV was categorized in tertiles and patients were stratified by baseline systolic BP. In summary, predialysis systolic BPV is an important, potentially modifiable risk factor for death and cardiovascular outcomes in incident hemodialysis patients. Studies of BP management in dialysis patients should focus on both absolute BP and BPV.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

April 2014

Volume

25

Issue

4

Start / End Page

799 / 809

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Systole
  • Renal Dialysis
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular Diseases
  • Aged
 

Citation

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Shafi, T., Sozio, S. M., Bandeen-Roche, K. J., Ephraim, P. L., Luly, J. R., St Peter, W. L., … DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators, . (2014). Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol, 25(4), 799–809. https://doi.org/10.1681/ASN.2013060667
Shafi, Tariq, Stephen M. Sozio, Karen J. Bandeen-Roche, Patti L. Ephraim, Jason R. Luly, Wendy L. St Peter, Aidan McDermott, et al. “Predialysis systolic BP variability and outcomes in hemodialysis patients.J Am Soc Nephrol 25, no. 4 (April 2014): 799–809. https://doi.org/10.1681/ASN.2013060667.
Shafi T, Sozio SM, Bandeen-Roche KJ, Ephraim PL, Luly JR, St Peter WL, et al. Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol. 2014 Apr;25(4):799–809.
Shafi, Tariq, et al. “Predialysis systolic BP variability and outcomes in hemodialysis patients.J Am Soc Nephrol, vol. 25, no. 4, Apr. 2014, pp. 799–809. Pubmed, doi:10.1681/ASN.2013060667.
Shafi T, Sozio SM, Bandeen-Roche KJ, Ephraim PL, Luly JR, St Peter WL, McDermott A, Scialla JJ, Crews DC, Tangri N, Miskulin DC, Michels WM, Jaar BG, Herzog CA, Zager PG, Meyer KB, Wu AW, Boulware LE, DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators. Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol. 2014 Apr;25(4):799–809.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

April 2014

Volume

25

Issue

4

Start / End Page

799 / 809

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Systole
  • Renal Dialysis
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular Diseases
  • Aged