title: Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes.
abstract: Pulse pressure is a well established marker of vascular stiffness and is associated with increased mortality in hemodialysis patients. Here we sought to determine if a decrease in pulse pressure during hemodialysis was associated with improved outcomes using data from 438 hemodialysis patients enrolled in the 6-month Crit-Line Intradialytic Monitoring Benefit Study. The relationship between changes in pulse pressure during dialysis (2-week average) and the primary end point of non-access-related hospitalization and death were adjusted for demographics, comorbidities, medications, and laboratory variables. In the analyses that included both pre- and post-dialysis pulse pressure, higher pre-dialysis and lower post-dialysis pulse pressure were associated with a decreased hazard of the primary end point. Further, every 10 mm Hg decrease in pulse pressure during dialysis was associated with a 20% lower hazard of the primary end point. In separate models that included pulse pressure and the change in pulse pressure during dialysis, neither pre- nor post-dialysis pulse pressure were associated with the primary end point, but each 10 mm Hg decrease in pulse pressure during dialysis was associated with about a 20% lower hazard of the primary end point. Our study found that in prevalent dialysis subjects, a decrease in pulse pressure during dialysis was associated with improved outcomes. Further study is needed to identify how to control pulse pressure to improve outcomes.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-8523, USA. jula.inrig@utsouthwestern.edu
authors.forename: Jula K
authors.initials: JK
authors.lastname: Inrig
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Robert D
authors.initials: RD
authors.lastname: Toto
authors.forename: Donal N
authors.initials: DN
authors.lastname: Reddan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lindsay
authors.forename: John
authors.initials: J
authors.lastname: Stivelman
authors.forename: James F
authors.initials: JF
authors.lastname: Winchester
authors.forename: Lynda A
authors.initials: LA
authors.lastname: Szczech
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome