Patients’ pulse pressure (PP) prior to hemodialysis (HD) sessions may predict mortality, investigators reported at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference. The finding may aid in HD patient risk stratification.

Consistently high PP values are associated with arterial stiffness, whereas low PP values may be associated with congestive heart failure, the investigators explained. The association between pre-HD PP with mortality among HD patients is not well understood.

Based on an analysis of data from 152,625 patients receiving HD at Fresenius Medical Care facilities, Hanjie Zhang, PhD, and colleagues at the Renal Research Institute in New York, New York, found that the association of pre-HD PP with mortality is nonlinear: pre-HD PP less than 49.2 mm Hg and higher than 74.7 mm Hg were associated with higher mortality compared with a PP range of 49.2 to 74.7 mm Hg. A better understanding of the nonlinearity will provide further insights into disentangling the associated mediators affecting its mechanisms, according to the investigators.  

Dr Zhang and colleagues calculated pre-HD PP by subtracting pre-HD diastolic blood pressure values from pre-HD systolic blood pressure values. Of the 152,625 patients, 40.4% died during a median follow-up of 26 months. The investigators built Cox proportional hazards models with spline terms, allowing them to model nonlinear effects of pre-HD PP as a continuous variable and its relationship with all-cause mortality.


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Reference

Zhang H, Cherif A, Kotanko P. Association of all-cause mortality with pre-hemodialysis pulse pressure in chronic hemodialysis patients. Presented at: Kidney Week 2020 Reimagined virtual conference, October 19 to 25. Poster PO1044.