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Comparison of intradialytic blood pressure metrics as predictors of all-cause mortality

Authors
Kim, Ka YoungPark, Hae SangKim, Jin SunAhn, Shin YoungKo, Gang JeeKwon, Young JooKim, Ji Eun
Issue Date
Dec-2021
Publisher
Oxford University Press
Keywords
blood pressure; end-stage renal disease; hemodialysis; intradialytic hypotension; mortality; prediction; receiver operating characteristics
Citation
CKJ: Clinical Kidney Journal, v.14, no.12, pp.2600 - 2605
Indexed
SCIE
SCOPUS
Journal Title
CKJ: Clinical Kidney Journal
Volume
14
Number
12
Start Page
2600
End Page
2605
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/55078
DOI
10.1093/ckj/sfab124
ISSN
2048-8505
Abstract
Background Intradialytic hypotension (IDH) has been reported to be an important prognostic factor in hemodialysis patients. However, a standard definition of IDH has not yet been determined. Methods We retrospectively analyzed blood pressure (BP) metrics obtained during serial dialysis sessions over a 90-day period from a single dialysis center from 2016 to 2017. The mean values and the frequency of specific values of BP were analyzed as predictors of 3-year mortality. Results A total of 430 patients who underwent maintenance dialysis were included. The mean age was 63.3 ± 12.4 years and 58.6% were male. A low minimum systolic blood pressure (SBP) <110 mmHg during dialysis was significantly associated with increased all-cause mortality. The frequency of a minimum SBP <100 mmHg was the most significant predictor of 3-year mortality, with an area under the curve (AUC) of 0.722. Furthermore, the frequency of a minimum SBP <100 mmHg significantly increased the predictability of mortality when combined with the presence of other clinical factors including age, body mass index and vascular access type (AUC 0.786 vs. 0.835; p = 0.005). Conclusion Among the various intradialytic BP metrics, the frequency of a minimum SBP <100 mmHg is the most significant factor related to all-cause mortality. The guidelines for the management of blood pressure in dialysis patients should consider including a minimum SBP <100 mmHg as a definition for IDH.
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Ahn, Shin Young
Guro Hospital (Department of Nephrology and Hypertension, Guro Hospital)
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