Modest declines in blood pressure (BP) after hemodialysis (HD) are associated with the greatest survival, whereas any rise or large decline in BP is associated with worse survival, according to researchers.

“BP change between pre- and post-HD could be highlighted as a therapeutic target for further improving patients’ outcomes,” concluded a team led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine School of Medicine in Orange.

Dr. Kalantar-Zadeh and his colleagues analyzed data from 113,255 HD patients to evaluate an association between change in BP during HD and mortality. They defined change in BP as post-HD minus pre-HD BP. They used the mean of BP change values during the HD session as a mortality predictor.

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Over a median follow-up of 2.2 years, 53,461 subjects (47.2%) died from any cause and 21,548 (25.7%) died from cardiovascular causes. Post-HD declines in systolic BP between -30 and 0 mm Hg were associated with improved survival. The investigators observed the greatest survival among patients who had a 14 mm Hg decrease in systolic BP, which was associated with an 8% decreased risk of mortality in adjusted analyses, the researchers reported online in Kidney International. Large decreases in systolic BP (greater than 30 mm Hg), however, were associated with increased mortality.

The researchers also observed better survival among patients whose change in diastolic BP was between -15 and 5 mm Hg. The greatest survival was observed among subjects with a diastolic BP decrease of 6 mm Hg, which was associated with a 7% decreased risk of death.