Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes

• Published in: Kidney international Vol. 76; no. 10; pp. 1098 - 1107
• Main Authors: Inrig, Jula K., Patel, Uptal D., Toto, Robert D., Reddan, Donal N., Himmelfarb, Jonathan, Lindsay, Robert M., Stivelman, John, Winchester, James F., Szczech, Lynda A.
• Format: Journal Article
• Language: English
• Published: Basingstoke Elsevier Inc 01.11.2009; Nature Publishing Group; Elsevier Limited
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Cohort Studies; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Female; hemodialysis; Humans; Intensive care medicine; intradialytic blood pressure; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Male; Medical sciences; Middle Aged; morbidity and mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; outcomes; pulse pressure; Renal Dialysis; Renal failure; Time Factors; Treatment Outcome; intradialytic blood pressure; hemodialysis; pulse pressure; morbidity and mortality; end-stage renal disease; outcomes; Kidney disease; Nephrology; Urinary system disease; Prognosis; Chronic renal failure; Hemodialysis; Mortality; Terminal stage; Epidemiology; Morbidity; Urology; Extrarenal dialysis; Renal failure; Arterial pressure; Blood pressure; Hemodynamics
• ISSN: 0085-2538; 1523-1755; 1523-1755
• DOI: 10.1038/ki.2009.340

Pulse pressure is a well established marker of vascular stiffness and is associated with increased mortality in hemodialysis patients. Here we sought to determine if a decrease in pulse pressure during hemodialysis was associated with improved outcomes using data from 438 hemodialysis patients enrolled in the 6-month Crit-Line Intradialytic Monitoring Benefit Study. The relationship between changes in pulse pressure during dialysis (2-week average) and the primary end point of non-access-related hospitalization and death were adjusted for demographics, comorbidities, medications, and laboratory variables. In the analyses that included both pre- and post-dialysis pulse pressure, higher pre-dialysis and lower post-dialysis pulse pressure were associated with a decreased hazard of the primary end point. Further, every 10mmHg decrease in pulse pressure during dialysis was associated with a 20% lower hazard of the primary end point. In separate models that included pulse pressure and the change in pulse pressure during dialysis, neither pre- nor post-dialysis pulse pressure were associated with the primary end point, but each 10mmHg decrease in pulse pressure during dialysis was associated with about a 20% lower hazard of the primary end point. Our study found that in prevalent dialysis subjects, a decrease in pulse pressure during dialysis was associated with improved outcomes. Further study is needed to identify how to control pulse pressure to improve outcomes.