Blood Pressure and Mortality Among Hemodialysis Patients
Open accessAbstract
Blood pressure measured before and after dialysis does not agree well with those recorded outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of greater prognostic value than blood pressure obtained just before and after dialysis remains incompletely understood. Among 326 patients on long-term hemodialysis, blood pressure was self-measured at home for 1 week, over an interdialytic interval by ambulatory recording and before and after dialysis over 2 weeks. Over a mean follow-up of 32 (SD 20) months, 102 patients died (31%), yielding a crude mortality rate of 118/1000 patient years. Systolic but not diastolic blood pressure was found to be of prognostic importance. Adjusted and unadjusted multivariate analyses showed increasing quartiles of ambulatory and home systolic blood pressure to be associated with all-cause mortality (adjusted hazard ratios for increasing quartiles of ambulatory: 2.51, 3.43, 2.62; and for home blood pressure: 2.15, 1.7, 1.44). Mortality was lowest when home systolic blood pressure was between 120 to 130 mm Hg and ambulatory systolic blood pressure was between 110 to 120 mm Hg. Blood pressure recorded before and after dialysis was not statistically significant ( P =0.17 for predialysis, and P =0.997 for postdialysis) in predicting mortality. Out-of-dialysis unit blood pressure measurement provided superior prognostic information compared to blood pressure within the dialysis unit (likelihood ratio test, P <0.05). Out-of-dialysis unit blood pressure among hemodialysis patients is prognostically more informative than that recorded just before and after dialysis. Therefore, the management of hypertension among these patients should focus on blood pressure recordings outside the dialysis unit.
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Patients with CKD on haemodialysis are profoundly different from patients with CKD not on dialysis because of varying states of volume excess and volume accumulation in the interdialytic period.
“Patients with CKD on haemodialysis are profoundly different from patients with CKD who are not on dialysis; this is so because of varying states of volume excess among patients and volume accumulation in the interdialytic period [204–206].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [206]
The Introduction discusses blood-pressure measurement in hemodialysis patients, and the Discussion briefly compares blood-pressure findings with those in CKD patients not on dialysis. Neither passage attributes a difference between the groups to volume excess or interdialytic volume accumulation. Searches for volume excess, fluid accumulation, and interdialytic weight gain found no passage addressing that explanation. (LLM, conf=0.72)
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References 24 · Cited by 274
Research works printed but not linked: 20
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- Authors
- Agarwal, R.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Corresponding author
- Agarwal, Rajiv
- ORCID
- Agarwal, Rajiv
- Venue
- Hypertension
- Published
- 2010-03
- Volume
- 55
- Issue
- 3
- Pages
- 762-768
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC2825286
- OpenAlex
- W2046735593
- Cited by
- 274
- References
- 24
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 8 · 2023: 21 · 2022: 17 · 2021: 12 · 2020: 18 · 2019: 18 · 2018: 19 · 2017: 19 · 2016: 26 · 2015: 20 · 2014: 19 · 2013: 12 · 2012: 18
- FWCI
- 14.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK062030, 2R01-DK062030-06A109)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Keywords
- hemodialysis, blood pressure, mortality, prognostic value, home blood pressure monitoring, ambulatory blood pressure monitoring, predialysis blood pressure, systolic blood pressure, antihypertensive therapy, end-stage renal disease
- MeSH terms
- Adult, Aged, Blood Pressure, Female, Follow-Up Studies, Renal Dialysis, Humans, Hypertension, Renal, Kidney Failure, Chronic, Male, Middle Aged, Morbidity, Predictive Value of Tests, Prognosis, Cohort Studies, Proportional Hazards Models, Nonlinear Dynamics, Blood Pressure Monitoring, Ambulatory, Kaplan-Meier Estimate
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