Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes
Inrig, Jula K.
Patel, Uptal D.
Toto, Robert D.
Reddan, Donal N.
Lindsay, Robert M.
Winchester, James F.
Szczech, Lynda A.
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Inrig, Jula K. Patel, Uptal D.; Toto, Robert D.; Reddan, Donal N.; Himmelfarb, Jonathan; Lindsay, Robert M.; Stivelman, John; Winchester, James F.; Szczech, Lynda A. (2009). Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes. Kidney International 76 (10), 1098-1107
Pulse pressure is a well established marker of vascular stiffness and is associated with increased mortality in hemodialysis patients. Here we sought to determine if a decrease in pulse pressure during hemodialysis was associated with improved outcomes using data from 438 hemodialysis patients enrolled in the 6-month Crit-Line Intradialytic Monitoring Benefit Study. The relationship between changes in pulse pressure during dialysis (2-week average) and the primary end point of non-access-related hospitalization and death were adjusted for demographics, comorbidities, medications, and laboratory variables. In the analyses that included both pre- and post-dialysis pulse pressure, higher pre-dialysis and lower post-dialysis pulse pressure were associated with a decreased hazard of the primary end point. Further, every 10 mm Hg decrease in pulse pressure during dialysis was associated with a 20% lower hazard of the primary end point. In separate models that included pulse pressure and the change in pulse pressure during dialysis, neither pre- nor post-dialysis pulse pressure were associated with the primary end point, but each 10 mm Hg decrease in pulse pressure during dialysis was associated with about a 20% lower hazard of the primary end point. Our study found that in prevalent dialysis subjects, a decrease in pulse pressure during dialysis was associated with improved outcomes. Further study is needed to identify how to control pulse pressure to improve outcomes. Kidney International (2009) 76, 1098-1107; doi: 10.1038/ki.2009.340; published online 2 September 2009