Blood Pressure Variability During Hemodialysis Raises Death Risk

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Greater variability in systolic blood pressure (SBP) in hemodialysis (HD) patients is independently associated with increased all-cause and cardiovascular mortality, a new study suggests.

In a study of 6,393 randomly selected adult HD patients, a team led by Jennifer E. Flythe, MD, of Brigham and Women's Hospital in Boston found that patients with high SBP variability (i.e., greater than the median) had a 26% increased risk of all-cause mortality and a 32% increased risk of cardiovascular mortality in adjusted analyses, according to findings published online ahead of print in the American Journal of Kidney Diseases.

The researchers noted that, to their knowledge, no prior study has examined the association between BP variability during dialysis and adverse outcomes.

“BP variability is one particularly compelling and understudied putative cardiovascular risk factor for the HD population,” the researchers observed. “Dialysis patients are routinely exposed to nonphysiologic fluid and osmolar shifts during the dialytic procedure that, when combined with impaired counter-regulatory responses, promote more prominent BP changes than are encountered in almost any other clinical circumstance.”

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