Among patients receiving hemodialysis, blood pressure control presents challenges requiring multiple medications and aggressive control of fluid gain. Lacking robust guidelines regarding patients on hemodialysis, nephrologists commonly rely on blood pressure targets derived from non-hemodialysis patients. Manasi Tannu, MD, and Jose Navarrete, MD, at the Emory University School of Medicine, Atlanta, Georgia, conducted a retrospective cohort study to examine whether achieving a normal blood pressure post dialysis is associated with better survival.
The researchers reported results of the study in a presentation during the NKF Spring Clinical meetings. The presentation was titled Post-Hemodialysis Blood Pressure and Risk of Death.
The study included 855 incident hemodialysis patients admitted to Emory Dialysis from January 2011 to December 2015; follow-up continued until December 2018.
Following adjustment for age, weight, diabetes, Kt/V, and ultrafiltration rate (UFR), there was an association between a post-dialysis mean arterial pressure (MAP) of 107 mmHg or less (equivalent to blood pressure 140/90) and a significant increase in the risk of death (hazard ratio, 1.53; 95% confidence interval, 1.1-2.1). Patients with an MAP of 107 mmHg or less were older (60 vs 57 years) with similar UF (1.8 vs 1.9 L), UFR (6.4 vs 7.2 mL/h/kg), and prevalence of diabetes (40%) and congestive heart failure (20%) than those with higher post-dialysis MAP. In patients with post-dialysis MAP of 107 mmHg or less, the risk of severe hypotension (MAP <60 mmHg) was more common than in patients with higher post-dialysis MAP (5.4% vs 1.5%).
In summary, the researchers said, “A post-hemodialysis MAP of 107 mmHg or less was associated with a higher risk of death as well as a higher risk of hypotensive episodes during dialysis. These data suggest that blood pressure goals for the non-dialysis population should not be used in hemodialysis patients. Further, aggressive blood pressure control increases the risk of hypotension during dialysis, perhaps contributing to the higher mortality observed in patients with post-hemodialysis MAP of 107 mmHg or less.”
Source: Tannu M, Navarrette J. Post-hemodialysis blood pressure and risk of death. Abstract of a presentation at the National Kidney Foundation 2020 Spring Clinical Meetings; abstract #203.