Abstract 17181: Association of Intradialytic Hypertension and Mortality According to Responsiveness to Ultrafiltration
Introduction: There are mixed data about the association of intradialytic hypertension and mortality in hemodialysis patients. Ultrafiltration (UF) during hemodialysis (HD) can effectively lower blood pressure in some but not all dialysis patients. We hypothesized that intradialytic hypertension that is non-responsive to ultrafiltration has the highest death risk.
Methods: We examined the association of nadir and change in intradialytic systolic BP (niSBP and ΔiSBP, respectively) with 5-year all-cause (2007-2011) mortality stratified by UF per treatment (defined as Pre-HD minus Post-HD weight) in a cohort of 112,013 incident adult HD patients using Cox regression models adjusted for case-mix, comorbidities, and lab covariates. ΔiSBP was defined as pre-HD SBP minus niSBP.
Results: We found that as UF increased, patients with niSBP ≥ 140 mmHg had a graded increase in mortality risk (p<0.001 when UF 3+). Additionally, ΔiSBP ≤ 15 mm Hg had an increasingly stronger association with mortality as UF increased up to < 3.0L. Patients with niSBP < 100 and ΔiSBP ≥ 50 mmHg were consistently found to have higher mortality risk (both p<0.001). All associations were robust to adjustment for demographics, laboratory values and comorbidities.
Conclusions: Our results suggest that intradialytic hypertension has a differential mortality risk. We found that intradialytic hypertension that is not reduced by ultrafiltration is associated with an increasingly higher mortality risk. Further studies are needed to identify the optimal niSBP and UF goals and their mechanisms of interaction.
Author Disclosures: J. Chou: None. E. Streja: None. D. Nguyen: None. M. Soohoo: None. Y. Obi: None. J.J. Sim: Other Research Support; Modest; Sanofi Aventis Pharmaceuticals, Mallinckroft Pharmaceuticals, Keryx Pharmaceuticals, Otsuka Pharmaceuticals. Consultant/Advisory Board; Modest; Advances in Chronic Kidney Disease. C.P. Kovesdy: Other Research Support; Modest; Abbvie, Amgen, Bayer, Janssen, Shire. Honoraria; Modest; Relypsa, ZS Pharma, Astra Zeneca, Nephrogenex. Consultant/Advisory Board; Modest; Relypsa, ZS Pharma, Astra Zeneca, Nephrogenex, American Journal of Kidney Disease, Nephrology Dialysis Transplantation, International Urology Nephrology, Nephron. Other; Modest; Royalties from UpToDate. K. Kalantar-Zadeh: Research Grant; Modest; NIH. Other Research Support; Modest; Shire, Aveo. Honoraria; Modest; Abbott, Abbvie, Amgen, ASN, Aveo, DaVita, Fresenius, Genetech, Hospira, Keryx, NIH, NKF, Relypsa, Resverlogix, Sanofi, Shire, Vifor, ZS-Pharma. Consultant/Advisory Board; Modest; Abbott, Abbvie, Amgen, AstraZeneca, Fresenius, Hospira, Keryx, Otsuka, Sanofi,Shire, Vifor, NIH: several study sections. Other; Modest; Prognostic assays for maintenance hemodialysis patients. Industry: Abbott, Abbvie, Amgen, Aveo, DaVita, Fresenius, Genetech, Hospira, Keryx,, NKF, Relypsa, Resverlogix, Sanofi, Shire, Vifor, ZS-Pharma.
- © 2016 by American Heart Association, Inc.