Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

doi:10.1038/s41440-025-02231-x

. 2025 Jul;48(7):2045-2057.

doi: 10.1038/s41440-025-02231-x. Epub 2025 May 19.

Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

Nobuhiko Joki^#^{1

2}, Tatsunori Toida^#^{1

3

4}, Kakuya Niihata^#⁴, Ryohei Inanaga^{4

5}, Kenji Nakata¹, Masanori Abe^{2

6}, Norio Hanafusa^{2

7}, Noriaki Kurita^{8

9

10}

Affiliations

¹ Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
² The Committee of Renal Data Registry, the Japanese Society for Dialysis Therapy, Tokyo, Japan.
³ School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Miyazaki, Japan.
⁴ Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.
⁵ Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan.
⁶ Divisions of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
⁷ Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan.
⁸ Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan. kuritanoriaki@gmail.com.
⁹ Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan. kuritanoriaki@gmail.com.
¹⁰ The Subcommittee of Statistical Analysis, The Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan. kuritanoriaki@gmail.com.

^# Contributed equally.

PMID: 40389635
DOI: 10.1038/s41440-025-02231-x

Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

Nobuhiko Joki et al. Hypertens Res. 2025 Jul.

. 2025 Jul;48(7):2045-2057.

doi: 10.1038/s41440-025-02231-x. Epub 2025 May 19.

Authors

Nobuhiko Joki^#^{1

2}, Tatsunori Toida^#^{1

3

4}, Kakuya Niihata^#⁴, Ryohei Inanaga^{4

5}, Kenji Nakata¹, Masanori Abe^{2

6}, Norio Hanafusa^{2

7}, Noriaki Kurita^{8

9

10}

Affiliations

¹ Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
² The Committee of Renal Data Registry, the Japanese Society for Dialysis Therapy, Tokyo, Japan.
³ School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Miyazaki, Japan.
⁴ Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.
⁵ Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan.
⁶ Divisions of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
⁷ Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan.
⁸ Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan. kuritanoriaki@gmail.com.
⁹ Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan. kuritanoriaki@gmail.com.
¹⁰ The Subcommittee of Statistical Analysis, The Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan. kuritanoriaki@gmail.com.

^# Contributed equally.

PMID: 40389635
DOI: 10.1038/s41440-025-02231-x

Abstract

The prognostic utility of the combined assessment of pre-hemodialysis systolic blood pressure (SBP) and pulse rate compared to their independent assessment is unclear. In this nationwide cohort study, we aimed to determine whether their combined assessment could enhance the prognostic utility in patients on maintenance hemodialysis using the Japanese Renal Data Registry database. Exposure was defined as a combination of SBP and pulse rate. Forty-eight levels of exposure groups were created: SBP (<100, 100- < 120, 120- < 140, 140- < 160 [reference], 160- < 180, and ≥180 mmHg) and pulse rate (<50, 50- < 60, 60- < 70 [reference], 70- < 80, 80- < 90, 90- < 100, 100- < 110, and ≥110 beats/min). The primary and secondary outcomes were 1-year all-cause and cardiovascular mortalities, respectively. Multivariate Cox proportional hazards models were used, and multiplicative and additive interactions were assessed. The combined model for mortality and cardiac mortality was statistically better than the separate SBP and pulse rate model. Lower SBP was associated with higher risk of all-cause mortality irrespective of pulse rate. Most categories of lower SBP or higher pulse rate vs. the 120- < 140 mmHg and 70- < 80 beats/min category had positive relative excess risk due to interactions, with similar findings observed for cardiac mortality. Combined assessment of pre-dialysis SBP and pulse rate may help the simple stratification of patients with excess risks that cannot be identified by separate SBP and pulse rate assessment.

Keywords: Additive interaction; Hemodialysis; Mortality; Pulse rate; Systolic blood pressure.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: TT received consulting fees from Astellas Pharma Inc., as well as payments and educational events from Torii Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., AstraZeneca K.K., and Nobelpharma Co., Ltd. RI received payment for speaking from Astellas Pharma, Inc., Novartis Pharma K.K., and Otsuka Pharmaceutical. MA received payment for speaking from Novartis Pharma K.K. and Otsuka Pharmaceutical. NK received consulting fees from GlaxoSmithKline K.K. and payments for speaking and educational events from Eisai Co., Ltd., Taisho Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., GlaxoSmithKline K.K., Takeda Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., and Baxter Corporation. Consent: The requirement for written informed consent was waived owing to the retrospective nature of this study.

References

1. Kurita N, Akizawa T, Fukuhara S. Vitality measured as self-reported energy level and clinical outcomes in hemodialysis patients: the Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS). Am J Kidney Dis. 2019;73:486–95. https://doi.org/10.1053/j.ajkd.2018.10.001 - DOI - PubMed
1. Hannedouche T, Roth H, Krummel T, London GM, Jean G, Bouchet J-L, et al. Multiphasic effects of blood pressure on survival in hemodialysis patients. Kidney Int. 2016;90:674–84. https://doi.org/10.1016/j.kint.2016.05.025 - DOI - PubMed
1. Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, et al. U” curve association of blood pressure and mortality in hemodialysis patients. Med Dir Dial Clin Inc Kidney Int. 1998;54:561–9. https://doi.org/10.1046/j.1523-1755.1998.00005.x - DOI
1. Robinson BM, Tong L, Zhang J, Wolfe RA, Goodkin DA, Greenwood RN, et al. Blood pressure levels and mortality risk among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2012;82:570–80. https://doi.org/10.1038/ki.2012.136 - DOI - PubMed - PMC
1. Inoue T, Tokuyama K, Yoshi S, Nagayoshi N, Iseki C, Iseki K. Elevated resting heart rate is an independent predictor of all-cause death and cardiovascular events in Japanese ambulatory hemodialysis patients. Clin Exp Nephrol. 2012;16:938–44. https://doi.org/10.1007/s10157-012-0641-3 - DOI - PubMed

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[1] Kurita N, Akizawa T, Fukuhara S. Vitality measured as self-reported energy level and clinical outcomes in hemodialysis patients: the Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS). Am J Kidney Dis. 2019;73:486–95. https://doi.org/10.1053/j.ajkd.2018.10.001 - DOI - PubMed

[2] Kurita N, Akizawa T, Fukuhara S. Vitality measured as self-reported energy level and clinical outcomes in hemodialysis patients: the Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS). Am J Kidney Dis. 2019;73:486–95. https://doi.org/10.1053/j.ajkd.2018.10.001 - DOI - PubMed

[3] Hannedouche T, Roth H, Krummel T, London GM, Jean G, Bouchet J-L, et al. Multiphasic effects of blood pressure on survival in hemodialysis patients. Kidney Int. 2016;90:674–84. https://doi.org/10.1016/j.kint.2016.05.025 - DOI - PubMed

[4] Hannedouche T, Roth H, Krummel T, London GM, Jean G, Bouchet J-L, et al. Multiphasic effects of blood pressure on survival in hemodialysis patients. Kidney Int. 2016;90:674–84. https://doi.org/10.1016/j.kint.2016.05.025 - DOI - PubMed

[5] Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, et al. U” curve association of blood pressure and mortality in hemodialysis patients. Med Dir Dial Clin Inc Kidney Int. 1998;54:561–9. https://doi.org/10.1046/j.1523-1755.1998.00005.x - DOI

[6] Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, et al. U” curve association of blood pressure and mortality in hemodialysis patients. Med Dir Dial Clin Inc Kidney Int. 1998;54:561–9. https://doi.org/10.1046/j.1523-1755.1998.00005.x - DOI

[7] Robinson BM, Tong L, Zhang J, Wolfe RA, Goodkin DA, Greenwood RN, et al. Blood pressure levels and mortality risk among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2012;82:570–80. https://doi.org/10.1038/ki.2012.136 - DOI - PubMed - PMC

[8] Robinson BM, Tong L, Zhang J, Wolfe RA, Goodkin DA, Greenwood RN, et al. Blood pressure levels and mortality risk among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2012;82:570–80. https://doi.org/10.1038/ki.2012.136 - DOI - PubMed - PMC

[9] Inoue T, Tokuyama K, Yoshi S, Nagayoshi N, Iseki C, Iseki K. Elevated resting heart rate is an independent predictor of all-cause death and cardiovascular events in Japanese ambulatory hemodialysis patients. Clin Exp Nephrol. 2012;16:938–44. https://doi.org/10.1007/s10157-012-0641-3 - DOI - PubMed

[10] Inoue T, Tokuyama K, Yoshi S, Nagayoshi N, Iseki C, Iseki K. Elevated resting heart rate is an independent predictor of all-cause death and cardiovascular events in Japanese ambulatory hemodialysis patients. Clin Exp Nephrol. 2012;16:938–44. https://doi.org/10.1007/s10157-012-0641-3 - DOI - PubMed

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Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

Affiliations

Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

LinkOut - more resources

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