title: Early changes in body weight and blood pressure are associated with mortality in incident dialysis patients.
abstract: BACKGROUND
  While much research is devoted to identifying novel biomarkers, addressing the prognostic value of routinely measured clinical parameters is of great interest. We studied early blood pressure (BP) and body weight (BW) trajectories in incident haemodialysis patients and their association with all-cause mortality.
  
  
  METHODS
  In a cohort of 357 incident patients, we obtained all records of BP and BW during the first 90 days on dialysis (over 12 800 observations) and analysed trajectories using penalized B-splines and mixed linear regression models. Baseline comorbidities and all-cause mortality (median follow-up: 2.2 years) were obtained from the French Renal Epidemiology and Information Network (REIN) registry, and the association with mortality was assessed by Cox models adjusting for baseline comorbidities.
  
  
  RESULTS
  During the initial 90 days on dialysis, there were non-linear decreases in BP and BW, with milder slopes after 15 days [systolic BP (SBP)] or 30 days [diastolic BP (DBP) and BW]. SBP or DBP levels at dialysis initiation and changes in BW occurring in the first month or during the following 2 months were significantly associated with survival. In multivariate models adjusting for baseline comorbidities and prescriptions, higher SBP value and BW slopes were independently associated with a lower risk of mortality. Hazard ratios of mortality and 95% confidence intervals were 0.92 (0.85-0.99) for a 10 mmHg higher SBP and 0.76 (0.66-0.88) for a 1 kg/month higher BW change on Days 30-90.
  
  
  CONCLUSIONS
  BW loss in the first weeks on dialysis is a strong and independent predictor of mortality. Low BP is also associated with mortality and is probably the consequence of underlying cardiovascular diseases. These early markers appear to be valuable prognostic factors.
authors.affiliation: RD - Néphrologie/EA7288 , Université Montpellier , Montpellier, France.
authors.forename: Flore
authors.initials: F
authors.lastname: Duranton
authors.affiliation: EA2415 , Institut Universitaire de Recherche Clinique, Université Montpellier , Montpellier, France.
authors.forename: Yohan
authors.initials: Y
authors.lastname: Duny
authors.affiliation: Néphrologie Dialyse Saint Guilhem , Sète , France.
authors.forename: Ilan
authors.initials: I
authors.lastname: Szwarc
authors.affiliation: NephroCare, Castelnau-le-Lez , France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Deleuze
authors.affiliation: NephroCare, Castelnau-le-Lez , France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Rouanet
authors.affiliation: NephroCare, Castelnau-le-Lez , France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Selcer
authors.affiliation: NephroCare, Castelnau-le-Lez , France.
authors.forename: François
authors.initials: F
authors.lastname: Maurice
authors.affiliation: NephroCare, Castelnau-le-Lez , France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Rivory
authors.affiliation: Néphrologie Dialyse Saint Guilhem , Sète , France.
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Servel
authors.affiliation: EA7288 , UFR Pharmacie, Université Montpellier , Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Jover
authors.affiliation: Service de Néphrologie, CHU de La Conception , Université Aix - Marseille , Marseille , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunet
authors.affiliation: EA2415 , Institut Universitaire de Recherche Clinique, Université Montpellier , Montpellier, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daurès
authors.affiliation: RD - Néphrologie/EA7288, Université Montpellier, Montpellier, France; Néphrologie Dialyse Saint Guilhem, Sète, France.
authors.forename: Àngel
authors.initials: À
authors.lastname: Argilés
keywords: blood pressure; body weight; haemodialysis; incident; mortality