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Titolo A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival
Autore Jongha Park1,2, Connie M. Rhee1,3, John J. Sim4, Yong-Lim Kim5, Joni Ricks1, Elani Streja1, Tania Vashistha1, Ramin Tolouian6, Csaba P. Kovesdy7,8 and Kamyar Kalantar-Zadeh1,9 1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California - Irvine, School of Medicine, Orange, California, USA; 2Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 3Division of Nephrology, Brigham and Women’s Hospital, Boston, Massachusetts, USA; 4Division of Nephrology and Hypertension, Kaiser Permanente Medical Center, Los Angeles, California, USA; 5Division of Nephrology, Kyungpook National University School of Medicine, Daegu, Republic of Korea; 6Division of Nephrology and Hypertension, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA; 7Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA; 8Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA and 9Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
Referenza Kidney International (2013) 84, 795-802

It is not clear to what extent changes in blood pressure (BP) during hemodialysis affect or predict survival. Studying comparative outcomes of BP changes during hemodialysis can have major clinical implications including the impact on management strategies in hemodialysis patients. Here we undertook a retrospective cohort study of 113,255 hemodialysis patients over a 5-year period to evaluate an association between change in BP during hemodialysis and mortality. The change in BP was defined as post-hemodialysis minus pre-hemodialysis BP, and mean of BP change values during the hemodialysis session was used as a mortality predictor. The patients’ average age was 61 years old and consisted of 45% women, 32% African-Americans and 58% diabetics. Over a median follow-up of 2.2 years, a total of 53,461 (47.2%) all-cause and 21,548 (25.7%) cardiovascular deaths occurred. In a fully adjusted Cox regression model with restricted cubic splines, there was a U-shaped association between change in systolic BP and all-cause mortality. Post-dialytic drops in systolic BP between _30 and 0mmHg were associated with greater survival, but large decreases of systolic BP (more than _30mmHg) and any increase in systolic BP (over 0mmHg) were related to increased mortality. Peak survival was found at a change in systolic BP of _14mmHg. The U-shaped association was also found for cardiovascular mortality. Thus, modest declines in BP after hemodialysis are associated with the greatest survival, whereas any rise or large decline in BP is associated with worsened survival.

Data 07.10.2013
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