Arterial hypertension and survival in hemodialysis patients

THE AIM: to evaluate blood pressure (BP) level importance measured in different phases of “dialysis” week as a prognostic factor in hemodialysis patients. PATIENTS AND METHOD: correlation between BP level before, during and after dialysis in in-terdialytic interval and survival of patients was estimated in two years prospective study of one dialysis center. RESULTS: BP in most of patients decreases during dialysis session and continues to decrease in interdialysis interval. BP before first session was 146±24 and 85±14, second - 141±19 and 82±13, third - 141±23 and 84±15 mm Hg, being in target range (<140/90 mm Hg) in 57% of women and 48% of men. The interdialysis body mass gain (BM) was linked only with systolic BP measured before session (r=0.222; p=0.04), and diastolic BP measured at any time point, more closely - with predialysis values (r=0.454÷0.281; p<0.01). Two year survival (Kaplan-Meier) was not associated with predialysis and intradialysis BP; the association with postdialysis BP was close to significance in adjusted Cox regression model (p=0.051). Interdialysis BP higher 141 mm Hg (border of upper and middle tercile) was interrelated with mortality relative risk (RR) 3.23 (95%CI 1.08÷9.66); p=0.036. Regression model also included BM gain (RR=1.73 per 1% IWG), age (RR +7% per 1 year) and gender. Diastolic BP higher than 84 mm HG in interdialysis period was associated with increase of mortality level: RR=6.84 (95%CI 1.55÷30.2) p=0.011. CONCLUSION: BP in interdialysis period is significantly more important for survival than on dialysis.

«домашнее» артериальное давление, hemodialysis, arterial hypertension, «home» blood pressure, hyperhydration, survival

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