Predialysis systolic blood pressure evolution in incident hemodialysis patients: effects of the dry weight method and prognostic value.

Abstract:

BACKGROUND:The relationship between predialysis blood pressure (BP) and hemodialysis (HD) patient outcomes is controversial. We report the evolution of predialysis BP in incident patients treated with the dry weight method and its relationship with patients' outcomes. METHODS:Between January 2000 and 2009, 308 patients started HD treatment. Fluid was progressively removed. The patients were encouraged to accept long-hour dialysis session and to follow a salt-restricted diet. BP and body weight (BW) were recorded and analyzed at start (week 1, W1) and weeks 8, 12, 26 and 52. RESULTS:The predialysis systolic BP decreased from 142.1 at W1 to 130.7 mm Hg at W52. Postdialysis BW decreased from W1 to W8 (-5.0 ± 4.5%). It was correlated with the decrease of the predialysis systolic BP at W26 and W52. Whereas the patient survival was significantly lower in the lower predialysis systolic BP tertile at W1 like in previous reports calling this phenomenon 'reverse epidemiology', no relationship between predialysis BP levels and outcomes was found at W12, W26 and W52. The patients in the tertile of the greater predialysis systolic BP decrease at W12 had significantly better survival in the whole group and in hypertensive patients. This relationship remained significant in the Cox proportional-hazards analysis. CONCLUSIONS:Hence the dry weight method is efficient in decreasing the predialysis BP in incident HD patients. The initial BW decrease was correlated with BP decrease at W26 and W52. Early correction of BP by fluid removal erases the reverse epidemiology for BP and influences positively the patient survival.

journal_name

Blood Purif

journal_title

Blood purification

authors

Chazot C,Vo-Van C,Deleaval P,Lorriaux C,Hurot JM,Mayor B,Jean G

doi

10.1159/000337101

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

275-83

issue

4

eissn

0253-5068

issn

1421-9735

pii

000337101

journal_volume

33

pub_type

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