title: Early systolic blood pressure changes in incident hemodialysis patients are associated with mortality in the first year.
abstract: BACKGROUND
  In incident hemodialysis (HD) patients, the relationship between early systolic blood pressure (SBP) dynamics and mortality is unknown.
  
  
  METHODS
  Baseline SBP levels were stratified into 5 categories ranging from <120 and ≥180 mm Hg. Early pre-HD SBP change was defined as the slope of pre-HD SBP from week 1 to 12 and categorized in quartiles (Q1, lowest slope). SBP slopes were computed for each patient by simple linear regression.
  
  
  RESULTS
  In 3,446 incident HD patients (42% females, 44% black, age 62 ± 15 years), the median pre-HD SBP slope was -1.7 (Q1) to +2.3 (Q4) mm Hg/week. In an adjusted multivariate Cox regression analysis, patients with declining SBP (slope Q1) had higher mortality compared to patients with increasing pre-HD SBP (slope Q4) at 12 months (hazard ratio 2.01, 95% confidence interval 1.35-3.01). In addition, patients with baseline pre-HD SBP <120 mm Hg showed higher mortality compared to the reference group (SBP ≥180 mm Hg) at 12 months (hazard ratio 1.89, 95% confidence interval 1.03-3.45).
  
  
  CONCLUSIONS
  Baseline pre-HD SBP and early SBP dynamics are associated with mortality in the first year of dialysis. Patients who had low (pre-HD SBP <120 mm Hg) or declining SBP had the highest mortality rates. Particular attention is warranted in incident HD patients with low or declining SBP.
authors.affiliation: Department of Nephrology, Medical Faculty, Erciyes University, Kayseri, Turkey.
authors.forename: Murat H
authors.initials: MH
authors.lastname: Sipahioglu
authors.forename: Len
authors.initials: L
authors.lastname: Usvyat
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Samer R
authors.initials: SR
authors.lastname: Abbas
authors.forename: Jochen G
authors.initials: JG
authors.lastname: Raimann
authors.forename: Laura
authors.initials: L
authors.lastname: Rosales
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality* / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors