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. 2023 Aug 31;38(9):1992-2001.
doi: 10.1093/ndt/gfac329.

Long-term peridialytic blood pressure changes are related to mortality

Camiel L M de Roij van Zuijdewijn  1   2 , Paul A Rootjes  1   2 , Menso J Nubé  1   2 , Michiel L Bots  3 , Bernard Canaud  4   5 , Peter J Blankestijn  6 , Frans J van Ittersum  1   2 , Francisco Maduell  7 , Marion Morena  8 , Sanne A E Peters  9 , Andrew Davenport  10 , Robin W M Vernooij  3   6 , Muriel P C Grooteman  1   2 ; HDF Pooling Project investigators
Collaborators, Affiliations

Long-term peridialytic blood pressure changes are related to mortality

Camiel L M de Roij van Zuijdewijn et al. Nephrol Dial Transplant. .

Abstract

Background: In chronic haemodialysis (HD) patients, the relationship between long-term peridialytic blood pressure (BP) changes and mortality has not been investigated.

Methods: To evaluate whether long-term changes in peridialytic BP are related to mortality and whether treatment with HD or haemodiafiltration (HDF) differs in this respect, the combined individual participant data of three randomized controlled trials comparing HD with HDF were used. Time-varying Cox regression and joint models were applied.

Results: During a median follow-up of 2.94 years, 609 of 2011 patients died. As for pre-dialytic systolic BP (pre-SBP), a severe decline (≥21 mmHg) in the preceding 6 months was independently related to increased mortality [hazard ratio (HR) 1.61, P = .01] when compared with a moderate increase. Likewise, a severe decline in post-dialytic diastolic BP (DBP) was associated with increased mortality (adjusted HR 1.96, P < .0005). In contrast, joint models showed that every 5-mmHg increase in pre-SBP and post-DBP during total follow-up was related to reduced mortality (adjusted HR 0.97, P = .01 and 0.94, P = .03, respectively). No interaction was observed between BP changes and treatment modality.

Conclusion: Severe declines in pre-SBP and post-DBP in the preceding 6 months were independently related to mortality. Therefore peridialytic BP values should be interpreted in the context of their changes and not solely as an absolute value.

Keywords: blood pressure; haemodiafiltration; haemodialysis; joint models; long-term changes; mortality.

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Conflict of interest statement

P.A.R. reports grant support from Niercentrum aan de Amstel, Elyse Klinieken and B. Braun Avitum. B.C. is part-time employee of Fresenius Medical Care acting as a consultant. F.J.V.I. reports a fee from Alfa Sigma. F.M. reports consulting fees from Fresenius Medical Care and Baxter as well as honoraria from Medtronic and Nipro. S.A.E.P. reports support from a UK Medical Research Council Skills Development Fellowship. M.P.C.G. reports grant support from Niercentrum aan de Amstel, Elyse Klinieken and B. Braun Avitum; speaker's fees from Fresenius Medical Care (payment made to the institution) and royalty fees from Wolters Kluwer. M.J.N. reports grant support from Niercentrum aan de Amstel, Elyse Klinieken and B. Braun Avitum. The remaining authors report no conflicts of interest. The authors declare that the results presented in this article have not been published previously in whole or part, except in abstract format.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Relationship between the 6-month change in SBP measured (a) before, (b) after and (c) Δ (after − before) and mortality. Adjusted models were corrected for age, gender, history of CVD, dialysis vintage, BMI, diabetes and baseline BP (pre-dialytic SBP, post-dialytic SBP or Δdialytic SBP, respectively). Whiskers represent 95% CIs of the HR.
Figure 2:
Figure 2:
Relationship between the 6-month change in DBP measured (a) before, (b) after and (c) Δ (after − before) and mortality. Adjusted models were corrected for age, gender, history of CVD, dialysis vintage, BMI, diabetes and baseline BP (pre-dialytic DBP, post-dialytic DBP or Δdialytic DBP, respectively). Whiskers represent 95% CIs of the HR.
See this image and copyright information in PMC

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