Abstract

Aims. The relevance of peridialytic blood pressure in predicting death of patients on chronic hemodialysis is controversial. The aim of the study is to describe the association between standardized peridialytic blood pressures and 2-year cardiovascular mortality.

Patients and methods. A prospective, observational, open study was conducted on 131 chronic hemodialysis patients in the Alba-Iulia Dialysis Centre, who were followed up for 2 years. The patients were divided in 2 sub-groups, group S (Survivors) (n=121) and group D (Deceased) (n=10). During the first week of the study, pre- and postdialysis blood pressures were measured, during all 3 dialysis sessions of the week, using standardized methods. Clinical, biological and treatment parameters were recorded. The association between the above variables and cardiovascular mortality was investigated.

Results. In the survival curve analysis, a mean predialytic systolic blood pressure (m SBP) over 155 mm Hg was significantly associated with death, with a RR of 4.7; CI 95%= 1.48-14.9 (p=0.01); mean predialysis diastolic blood pressure (mDBP) >95 mm Hg was associated with a RR of death of 6.59; CI 95%=2.09-20.7 (p=0.001). Intradialytic hypotension was associated with a RR of 4.28; CI 95%=1.28- 14.26 (p=0.02). In logistic regression, statistically significant correlations with death were found for the following variables: predialysis mSBP ≥155 mm Hg, predialysis mDBP >95 mm Hg, intradialytic hypotension, Charlson comorbidity index >5, history of myocardial infarction, albuminemia <3.6 g/dl, cholesterolemia <150 mg/dl.

Conclusions. Standardized predialysis m SBP over 155 mm Hg, standardized predialysis mDBP over 95 mm Hg and intradialytic hypotension were significant predictors of death in our study group.

Keywords

blood pressure, hemodialysis, chronic renal failure, arterial hypertension, cardiovascular risk