Orthostatic hypotension at the introductory phase of haemodialysis predicts all-cause mortality.
BACKGROUND
Since the predictive value of orthostatic hypotension (OH) at the introductory phase of haemodialysis (HD) is unknown, we examined the association between OH and all-cause death in patients who started HD between 1987 and 2001.


METHODS
More than three consecutive blood pressure measurements before HD treatments (pre-HD BP) were made on each of 304 patients who had recently been started on HD and were in a stable condition. OH was defined as a drop in systolic BP of >20 mmHg or in diastolic BP of >10 mmHg after standing.


RESULTS
Of 304 patients, 42% had OH. OH was significantly associated with pre-HD supine systolic BP; its severity was significantly associated with a past history of cerebrovascular disease and pre-HD supine systolic BP. During a mean follow-up of 4.0+/-3.0 years (range 0.1-13.2 years), 136 deaths were recorded. A multivariate Cox proportional hazards model analysis demonstrated that OH and a past history of cerebrovascular disease were independent predictors of all-cause death. The comparison by Kaplan-Meier analysis of the overall survival of patients with and without OH was significant.


CONCLUSIONS
Our findings validate OH at the introductory phase of HD as a novel independent predictor of all-cause mortality among HD patients.
Sasaki
Osamu
O
Division of Hypertension and Nephrology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565-8565, Osaka, Japan.
Nakahama
Hajime
H
Nakamura
Satoko
S
Yoshihara
Fumiki
F
Inenaga
Takashi
T
Yoshii
Masayoshi
M
Kohno
Shigeru
S
Kawano
Yuhei
Y
D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007024:Hypotension, Orthostatic / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome