title: Predialysis systolic blood pressure evolution in incident hemodialysis patients: effects of the dry weight method and prognostic value.
abstract: BACKGROUND
  The relationship between predialysis blood pressure (BP) and hemodialysis (HD) patient outcomes is controversial. We report the evolution of predialysis BP in incident patients treated with the dry weight method and its relationship with patients' outcomes.
  
  
  METHODS
  Between January 2000 and 2009, 308 patients started HD treatment. Fluid was progressively removed. The patients were encouraged to accept long-hour dialysis session and to follow a salt-restricted diet. BP and body weight (BW) were recorded and analyzed at start (week 1, W1) and weeks 8, 12, 26 and 52.
  
  
  RESULTS
  The predialysis systolic BP decreased from 142.1 at W1 to 130.7 mm Hg at W52. Postdialysis BW decreased from W1 to W8 (-5.0 ± 4.5%). It was correlated with the decrease of the predialysis systolic BP at W26 and W52. Whereas the patient survival was significantly lower in the lower predialysis systolic BP tertile at W1 like in previous reports calling this phenomenon 'reverse epidemiology', no relationship between predialysis BP levels and outcomes was found at W12, W26 and W52. The patients in the tertile of the greater predialysis systolic BP decrease at W12 had significantly better survival in the whole group and in hypertensive patients. This relationship remained significant in the Cox proportional-hazards analysis.
  
  
  CONCLUSIONS
  Hence the dry weight method is efficient in decreasing the predialysis BP in incident HD patients. The initial BW decrease was correlated with BP decrease at W26 and W52. Early correction of BP by fluid removal erases the reverse epidemiology for BP and influences positively the patient survival.
authors.affiliation: NephroCare Tassin-Charcot, Sainte Foy Les Lyon, France. chchazot@gmail.com
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
authors.forename: Cyril
authors.initials: C
authors.lastname: Vo-Van
authors.forename: Patrik
authors.initials: P
authors.lastname: Deleaval
authors.forename: Christie
authors.initials: C
authors.lastname: Lorriaux
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Hurot
authors.forename: Brice
authors.initials: B
authors.lastname: Mayor
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001835:Body Weight; D015331:Cohort Studies; D004039:Diet, Sodium-Restricted / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome