Original InvestigationDialysisAssociation 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
Section snippets
Study Design
This study is a secondary analysis of a prospective cohort of incident dialysis patients enrolled in the Dialysis Morbidity and Mortality Study (DMMS) Wave 2.
Setting
All incident peritoneal dialysis patients and a 20% random sample of incident HD patients starting dialysis therapy during 1996 and 1997 in the United States were enrolled in the DMMS cohort. Entry into the cohort began 60 days after dialysis therapy initiation, at which time demographics, comorbid conditions, clinical variables,
Participants and Descriptive Data
Of 1,748 incident HD patients, 213 (12.2%) showed increases in SBP during HD greater than 10 mm Hg (Table 1). Figure 1 shows the distribution of changes in SBP during HD across the cohort of patients. In general, patients with intradialytic increases in SBP had lower dry weight, smaller body mass index, and lower interdialytic weight gain compared with patients with SBP that was unchanged or decreased with HD (P < 0.001 for all). Patients with intradialytic increases in SBP also had lower serum
Discussion
Intradialytic increase in BP is a known phenomenon of HD; however, this is the first study to identify its association with adverse 2-year clinical outcomes. Although clinicians often focus on intradialytic hypotension and its complications, intradialytic increases in BP often are largely ignored. Considering that our investigation identified an intradialytic increase in SBP to be associated with an increased hazard of death, particularly in patients with low predialysis SBP, additional
Acknowledgements
The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government. This work was presented in part at the American Society of Nephrology 41st Annual Meeting, Philadelphia, PA, November 6, 2008.
Support: Dr Inrig was supported by National Institutes of Health (NIH) grant K23 HL092297. Dr Patel was supported by NIH grant K23 DK075929.
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Originally published online as doi: 10.1053/j.ajkd.2009.05.012 on July 31, 2009.