title: Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk.
abstract: BACKGROUND
  Hemodialysis patients have a high cardiovascular mortality, and hypertension is the most prevalent treatable risk factor. We aimed to assess the predictive significance of dialysis-to-dialysis variability in blood pressure in hemodialysis patients.
  
  
  METHODS
  We performed a historical cohort study in 1,088 prevalent hemodialysis patients, followed up for 5 years. The risk of cardiovascular death was determined in relation to dialysis-to-dialysis variability in blood pressure, maximum blood pressure and pulse pressure.
  
  
  RESULTS
  Variability in blood pressure was a predictor of cardiovascular death (hazard ratio [HR] = 1.242; 95% confidence interval [95% CI], 1.004-1.537; p=0.046). Also age (HR=1.021; 95% CI, 1.011-1.048; p=0.049), diabetes (HR=1.134; 95% CI, 1.128-1.451; p=0.035), creatinine (HR=0.837; 95% CI, 0.717-0.977; p=0.024) and albumin (HR=0.901; 95% CI, 0.821-0.924; p=0.022) influenced mortality. Maximum blood pressure and pulse pressure did not show any effect on cardiovascular death.
  
  
  CONCLUSIONS
  Dialysis-to-dialysis variability in blood pressure is a predictor of cardiovascular mortality in hemodialysis patients, and blood pressure variability may be used in managing hypertension and predicting outcomes in dialysis patients.
authors.affiliation: Division of Nephrology, "A. Landolfi" Hospital, Solofra, Avellino, Italy. br.diiorio@libero.it
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Micco
authors.forename: Serena
authors.initials: S
authors.lastname: Torraca
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Sirico
authors.forename: Pasquale
authors.initials: P
authors.lastname: Guastaferro
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiuchiolo
authors.forename: Filippo
authors.initials: F
authors.lastname: Nigro
authors.forename: Antonietta
authors.initials: A
authors.lastname: De Blasio
authors.forename: Paolo
authors.initials: P
authors.lastname: Romano
authors.forename: Andrea
authors.initials: A
authors.lastname: Pota
authors.forename: Roberto
authors.initials: R
authors.lastname: Rubino
authors.forename: Luigi
authors.initials: L
authors.lastname: Morrone
authors.forename: Teodoro
authors.initials: T
authors.lastname: Lopez
authors.forename: Francesco Gaetano
authors.initials: FG
authors.lastname: Casino
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality*; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D003404:Creatinine