Haemodialysis-unresponsive blood pressure: cardiovascular mortality predictor?
OBJECTIVE
The importance of 'conventional' cardiovascular risk factors in haemodialysis (HD) patients has been questioned following evidence that pre-HD blood pressure (BP) might be inversely related to mortality in contrast to post-HD BP. To evaluate this reverse BP epidemiology in HD patients, HD-induced BP changes were compared with aortic pulse wave velocity (PWV), an independent predictor of cardiovascular mortality.


METHODS
Aortic PWV was evaluated in a limited care HD cohort, all of whom were asymptomatic of cardiovascular disease.


RESULTS
Of 47 limited care patients, 45% were classified as HD responsive, with a 17% fall in mean arterial pressure compared with a 6% increase in the HD-unresponsive group. While there were no significant differences between the two groups in traditional vascular disease risk factors or interdialytic weight loss, PWV was significantly elevated in the HD-unresponsive group (12.9 +/- 2.7 compared with 10.8 +/- 2.9; P < 0.05). Furthermore, there was a positive correlation between the change in BP during HD and PWV in all subjects (r = 0.500; P < 0.001 for systolic blood pressure (SBP), a correlation that also existed for diastolic blood pressure (DBP) (P < 0.01).


CONCLUSIONS
This study suggests that patients with HD-unresponsive BP are more likely to have vascular disease and this association between PWV and HD-induced BP changes might partly explain the apparent paradox of pre- and post-HD BP with mortality. It is proposed that a population with elevated post-HD BP is more likely to be composed of subjects with vascular disease (overt or occult), in contrast to a group with high pre-HD BP, which will be more heterogeneous.
Mourad
Adnan
A
Department of Nephrology, John Hunter Hospital, New Lambton Heights, NSW, Australia.
Khoshdel
Alireza
A
Carney
Shane
S
Gillies
Alastair
A
Jones
Bernard
B
Nanra
Ranjit
R
Trevillian
Paul
P
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003187:Compliance; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors