The effect of preand post-dialysis blood pressure and its variations during the hemodialysis procedure on the survival of patients in a 5-year cohort study conducted in real-life clinical setting


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Aim. To evaluate the effect of pre- and postdialysis hypertension, normo- and hypotension, as well as intradialysis changes in blood pressure (BP) on the survival of patients receiving program hemodialysis (HD). Material and methods. The study included 3723 patients who were on program hemodialysis at the dialysis centers of the B. Brown Avitum Russland network, and who started hemodialysis treatment from 2011 to 2016. BP was recorded before and after the dialysis procedure, and at least every hour during the dialysis procedure. The parameters of the averaged blood pressure over the follow-up period were analyzed. Results. The averaged mean pre-dialysis blood pressure was 140±15.8 and 84±9.8 mm Hg, postdialysis -134.9±15.2 and 82.4±15.2. Three-year active survival rate of patients from the moment of inclusion in the study was 86%, a five-year survival rate - 78%. According to the Kaplan-Meier statistical model, survival depended on the values of pre- and post-dialysis blood pressure. Before the dialisis session, the subgroup of the upper quartile of systolic blood pressure (SBP, P <0.0001), and the subgroup of the lower quartile of diastolic blood pressure (DBP, p=0.001) showed the worst survival rate with high statistical reliability. Evaluation of the relationship between blood pressure and survival in the Cox regression model showed a significant effect of low predialysis DBP; the lowest survival rate after the dialysis session was observed in patients with a decrease in SBP <126 mm Hg. Evaluation of intra-dialysis variations in blood pressure revealed statistical significancant intensive decrease in SBP during the hemodialysis procedure by more than 20 and 30 mm Hg. It was found that high ultrafiltration (UF) rates lead to a significant decrease in SBP after a dialysis session. There was also a weak but significant inverse correlation between the UV rates and the change in SBP during the procedure. Conclusion. Low predialysis DBP levels and elevated SBP, as well as a decrease in SBP after dialysis procedure below optimal values have a significant effect on the survival of patients with CKD-5D. The effect of changes in blood pressure during the dialysis session on survival was established: an intra-dialysis increase in SBP by more than 10 mm Hg and a fall in SBP by 20 mm Hg and below statistically significantly worsen the prognosis of patients on the program hemodialysis. Association of high ultrafiltration rates with fall of blood pressure at the end of the HD procedure was demonstrated.

Full Text

Restricted Access

About the authors

V. Yu Shylo

SBEI HPE "Moscow State Medical Stomatological University n.a. A.i. Evdokimov" of RMH; B. Braun Avitum Russland Clinics, Dialysis Center

Email: nephrolog@gmail.com
PhD in Medical Science, Associate Professor at the Department of Nephrology; medical director of the network

I. Yu Drachev

FSBEI he "Tver State Medical University" of RMH; B. Braun Avitum Russland Clinics, Dialysis Center

Postgraduate Student at the Department of Faculty Therapy; chief resident at the hemodialysis department MCHTP

References

  1. Бикбов Б.Т. Томилина Н.А. Факторы риска смерти больных, впервые начинающих лечение гемодиализом (по данным Регистра Российского диализного общества). Нефрология и диализ. 2008;10(1):35-43.
  2. Гендлин Г.Е., Тронина O.A., Сторожаков Г.И., Зайвая М.В., Этгингер O.A., Шило В.Ю., Перекокин Ю.Н. Сравнение показателей гемодинамики и эластических свойств сосудов у пациентов на программном гемодиализе (ПГД) и после аллотрансплантации почки (АТП). Нефрология и диализ. 2005;7(3):343-344.
  3. Зайвая М.В., Гендлин Г.Е., Сторожаков Г.И., Тронина O.A., Странгуль А.И., Шило В.Ю. Динамика артериального давления у больных на программном диализе во время сна и в междиализный период. Нефрология и диализ. 2005;7(3):327.
  4. Ляшенко О.А., Гуревич К.Я., Корнеев А.М. Клинические, лабораторные и инструментальные характеристики, ассоциированные с артериальной гипертензией у больных, находящихся на программном гемодиализе. Нефрология. 2011;15(2):49-56.
  5. Сабодаш А.Б. Салихова К.А. Земченков Г.А. Макарова О.В Динамика артериальной гипертензии и выживаемость у пациентов на гемодиализ. Нефрология и диализ. 2016;18(4):418-430.
  6. Agarwal R., Light R.P. Median intradialytic blood pressure can track changes evoked byprobing dry-weight. Clin. J. Am. Soc. Nephrol. 2010;5:897-904.
  7. Agarwal R. The controversies of diagnosing and treating hypertension among hemodialysis patients. Semin. Dial. 2012;25:370-376.
  8. Assimon M.M., Wenger J.B., Wang L., Flythe J.E. Ultrafiltration Rate and Mortality in Maintenance Hemodialysis Patients. Am. J. Kidney Dis. 2016;68(6):911-922.
  9. Burton J.O., Jefferies H.J., Selby N.M., McIntyre C.W. Hemodialysisinduced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin. J. Am. Soc. Nephrol. 2009;4:1925-1931.
  10. Chobanian A.V., Bakris G.L., Black H.R., Cushman W.C., Green L.A., Izzo J.L.Jr., Jones D.W., Materson B.J., Oparil S., Wright J.T. Jr., Roccella E.J. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.
  11. Cohen J.B., Townsend R.R. Antihypertensive medication in patients pre- and postdialysis: still hazy after all these years. Clin. J. Am. Soc. Nephrol. 2016. pii: CJN.06130616.
  12. Flythe J.E., Xue H., Lynch K.E., Curhan G.C., Brunelli S.M. Association of Mortality Risk with Various Definitions of Intradialytic Hypotension. J. Am. Soc. Nephrol. 2015;26:724-734.
  13. Flythe J.E., Inrig J.K., Shafi T. Chang T.I., Cape K., Dinesh K., Kunaparaju S., Brunelli S.M. Association of intradialytic blood pressure variability with increased all-cause and cardiovascular mortality in patients treated with longterm hemodialysis. Am. J. Kidney. Dis. 2013;61:966-974.
  14. Foley R.N., Parfrey P.S., Harnett J.D., Kent G.M., Murray D.C., Barre P.E. Impact of hypertension on cardiomyopathy, morbidity and mortality in endstage renal disease. Kidney International. 1996;49(5):1379-1385.
  15. Inrig J.K., Patel U.D., Toto R.D., Szczech L.A. 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. Am. J. Kidney Dis. 2009;54:881-890.
  16. Park J., Rhee C.M., Sim J.J, Kim Y.L., Ricks J., Streja E., Vashistha T., Tolouian R., Kovesdy C.P., Kalantar-Zadeh K. A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival. Kidney International. 2013;84(4):795-802.
  17. Kalantar-Zadeh K., Block G., Humphreys M.H., Kopple J.D. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney International. 2003;3:793-808.
  18. Khan A., Khan A.H., Adnan A.S., Syed Sulaiman S.A., Gan S.H., Khan I. Management of patient care in hemodialysis while focusing on cardiovascular disease events and the atypical role of hyper- and/or hypotension: a systematic review. Biomed Res. Int. 016;2016:9710965. Epub 2016 Oct. 19. Review.
  19. Assimon M.M., Flythe J.E. Rapid ultrafiltration rates and outcomes among hemodialysis patients: re-examining the evidence base. Curr. Opin. Nephrol. Hypertens. 2015;24(6):525-530.
  20. Movilli E., Gaggia P., Zubani R., Camerini C., Vizzardi V., Parrinello G., Savoldi S., Fischer M.S., Londrino F., Cancarini G. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol. Dial. Transplant. 2007:22:3547-3552.
  21. National Kidney Foundation. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. American Journal of Kidney Diseases. 2005;45(3):16-153.
  22. Parker T.F. 3rd, Hakim R., Nissenson A.R. Krishnan M., Bond T.C., Chan K., Maddux F.W., Glassock R. A quality initiative: reducing rates of hospitalizations by objectively monitoring volume removal Nephrol. News Issues. 2013;27:31-37.
  23. Port F.K., Hulbert-Shearon T. E., Wolfe R.A., Bloembergen W.E., Golper T.A., Agodoa L.Y., Young E.W. Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. American Journal of Kidney Diseases. 1999;33(3):507-517.
  24. Salem M.M., Bower J. Hypertension in the hemodialysis population: any relation to one-year survival? American Journal of Kidney Diseases. 1996:28(5):737-740.
  25. Shoji T., Tsubakihara Y., Fujii M., Imai E. Hemodialysis-associated hypotension as an independent riskfactorfor two-year mortality in hemodialysis patients. Kidney Int. 2004;66:1212-1220.
  26. Zager P.G., Nikolic J., Brown R.H., Campbell M.A., Hunt W.C., Peterson D., Van Stone J., Levey A., Meyer K.B., Klag M.J., Johnson H.K., Clark E., Sadler J.H., Teredesai P. «U» curve association of blood pressure and mortality in hemodialysis patients. Kidney International. 1998;54(2): 561-569.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies