Abstract: SA-PO907
The Relation Between Peri-Dialytic Blood Pressure Changes over Time and Mortality Is Similar in Hemodialysis and Online Post-Dilution Hemodiafiltration
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- de Roij van Zuijdewijn, Camiel LM, VU University Medical Center, Amsterdam, Netherlands
- Rootjes, Paul A., VU University Medical Center, Amsterdam, Netherlands
- Blankestijn, Peter J., University Medical Center----, Utrecht, Netherlands
- Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany
- Davenport, Andrew, Royal Free Hospital, London, United Kingdom
- van Ittersum, Frans J., VU University Medical Center Amsterdam, Amsterdam, Netherlands
- Grooteman, Muriel P., VU University Medical Center Amsterdam, Amsterdam, Netherlands
- Maduell, Francisco, Hospital Clinic Barcelona, Barcelona, Spain
- Nube, Menso, VU Medical Center, Bergen, Netherlands
Group or Team Name
- on behalf of the HDF Pooling Project Investigators
Background
Online post-dilution hemodiafiltration (HDF) is associated with a lower mortality rate than hemodialysis (HD). The mechanism(s) behind this effect, however, is (are) unknown. In the present study we evaluated whether long-term changes in pre-, post-dialytical and delta (peri-dialytic) systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP) or pulse pressure (PP) may contribute to the beneficial effect of HDF on survival.
Methods
Individual Participant Data (IPD) from the Spanish Estudio de Supervivencia de Hemodiafiltración (ESHOL, n=906), the Dutch Convective Transport Study (CONTRAST, n=714) and the French HDF study (Frenchie, n=391) were pooled. The difference in peri-dialytic SBP, DBP, MAP and PP was calculated between baseline and 6 months and divided into tertiles: stable, decreasing and increasing peri-dialytic values. The stable tertile (which included a change of 0mmHg in 6 months) was used as reference group. All values were related to mortality for the entire study follow-up using Cox regression models using an intention-to-treat approach. Hereafter, models were adjusted for relevant confounders (age, sex, BMI, dialysis vintage, diabetes and history of cardiovascular disease).
Results
In 6 months, SBP, DBP, MAP and PP changed with a median of 0 (interquartile range [IQR] -18 to 18.25), 0 (IQR -10 to 10), 0.33 (IQR -11 to 11) and 0 (IQR -16 to 16) mmHg, respectively. While patients with a decreasing peri-dialytical SBP had a HR of 0.82 (95% CI 0.65-1.03), patients with an increasing peri-dialytical SBP had a HR of 1.01 (95% CI 0.81-1.26). For DBP, these HRs were 0.88 (95% CI 0.71-1.10) and 0.87 (95% CI 0.70-1.10), for MAP 0.79 (95% CI 0.62-0.99) and 1.09 (95% CI 0.88-1.35) and for PP 0.76 (95% CI 0.61-0.96) and 0.93 (95% CI 0.75-1.15). After correction for confounders, no significant relation was found.
Conclusion
Since the relation between the long-term peri-dialytical BP course (SBP, DBP, MAP or PP) and mortality was similar in HD and HDF patients and mortality is lower in HDF (Peters SAE et al. NDT 2016), other mechanisms, such as intradialytical BP stability, may more fundamentally affect survival. This hypothesis is currently under investigation.