Visit-to-visit systolic blood pressure variability associates with vascular thrombosis in hemodialysis patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.C Wu ◽  
P.S Lin ◽  
M.Y Hsieh ◽  
T.Y Chen ◽  
T.T Lin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Vascular Access ◽  
Blood Pressure Variability ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Funding Source ◽  
Vascular Events ◽  
Vascular Thrombosis ◽  
Co Morbidity

Abstract Background Blood pressure variability (BPV) is an independent risk factor for cardiovascular events and death in general population. Hemodialysis patients have higher BPV and higher vascular events than general population. However, the impact of BPV on vascular events of hemodialysis patients is not clear. Purpose To determine the association of BPV with vascular outcomes in patients on maintenance hemodialysis. Method In this prospective multi-center study, we enrolled 927 maintenance hemodialysis patients from Jan, 2017 to Dec, 2017. We used the coefficient of variation (CV) and the variance independent of mean (VIM) of predialysis systolic blood pressure (SBP) derived from the first 3 months (36 dialysis sessions) after enrollment as the metrics of BPV. Patients were prospectively followed at 3-month interval. Outcomes included death, systemic vascular thrombosis (nonfatal myocardial infarction, ischemic stroke, and acute limb ischemia), and dialysis vascular access thrombosis. Results In all, 707 subjects with at least 20 measurements were included in the analysis. Patients' mean age was 66 years and 50% of patients were male. Baseline factors associated higher BPV included diabetes, high co-morbidity scores, low albumin, high systolic and diastolic blood pressure. The mean pre-dialysis SBP CV was 10.9% and VIM was 28.9%. The median follow-up duration was 2.5 years, during which 103 deaths, 81 systemic vascular thrombosis, and 155 dialysis access thrombosis occurred. In unadjusted model, we found that the highest BPV tertile had a 52% increased risk of vascular thrombosis than the lowest BPV tertile (HR=1.52, 95% CI 1.23–1.86, P<0.001). After multivariable adjustment (including age, diabetes, co-morbidity score, albumin, baseline systolic and diastolic BP), this association remained statistically significant (HR=1.47, 95% CI=1.18–1.84, P=0.001). Systolic BPV was associated with either systemic vascular thrombosis (HR=1.44, 95% CI=1.08–1.93, P=0.01) or dialysis vascular access thrombosis (HR=1.55, 95% CI=1.16–1.82, P=0.001). Conclusion In the cohort of patients on maintenance hemodialysis, high pre-dialysis systolic BPV was associated a higher risk of vascular thrombosis events, both for systemic vascular thrombosis and dialysis vascular access thrombosis. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): National Taiwan University Hsinchu Branch

scholarly journals Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients

Medicine ◽  
2020 ◽  
Vol 99 (29) ◽  
pp. e21232
Author(s):  
Yue Cheng ◽  
Yunming Li ◽  
Fan Zhang ◽  
Jun Zhu ◽  
Tao Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Maintenance Hemodialysis Patients

scholarly journals Frailty is associated with vascular thrombosis events in chronic hemodialysis patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.C Wu ◽  
J.H Cheng ◽  
H.J Yang ◽  
L.I.N Ps ◽  
S.J Liu ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Vascular Access ◽  
Medical Records ◽  
Arterial Thrombosis ◽  
Primary Outcome ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Funding Source ◽  
Vascular Thrombosis

Abstract Background Frailty is common in chronic hemodialysis patients and is associated with increased risk of mortality. In hemodialysis patients, cardiovascular disease is the most cause of mortality but the impact of frailty on cardiovascular disease remained unknown. Purpose To access if there was an association between frailty and vascular thrombotic events among chronic hemodialysis patients. Methods This is a multi-center cohort study of chronic hemodialysis patients conducted since Jan, 2018 (last follow-up in December, 2020). Baseline data were collected from medical records and hemodialysis records. Frailty was defined by the Fried's criteria, a composite construct that incorporated poor physical functioning, exhaustion/fatigue, low physical activity, and undernutrition using a self-reported questionnaire. The primary outcome was vascular thrombosis events, defined as myocardial infarction, ischemic stroke, acute or critical limb ischemia, and dialysis vascular access thrombosis. The outcomes were assessed from a prospectively-collected nationwide registration system which was updated every 3 months and verified after review of medical records or discussion with caring physicians. Results During the study period, 571 chronic hemodialysis patients were enrolled. The mean age of study participants was 66 years old (SD, 13) and 55% of them were male. A total of 247 patients (43%) were categorized as frail. At baseline, logistic regression analysis revealed that older age, female sex, diabetes, low albumin and history of stroke were independently associated with frailty. During the follow-up period (median, 18 months), 57 patients (10%) died and 182 patients (31.9%) had vascular thrombosis events, including 101 arterial thrombosis (17.7%) and 105 dialysis access thrombosis (18.4%). In the primary outcome analysis, Cox proportional hazards modeling indicated that frailty was independently associated with vascular thrombosis events (Hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.132–2.597). In the secondary analysis, frailty was associated death (HR 2.25, CI 1.16–4.37), arterial thrombosis events (HR 1.92, CI 1.16–3.18), and dialysis vascular access thrombosis events (HR 1.90, CI 1.24–2.91). Conclusion Frailty phenotype is extremely common in hemodialysis patients. It is associated with mortality and vascular thrombosis events among chronic hemodialysis patients. Given its prevalence and consequence, research focus on interventions aimed to prevent or attenuate frailty in hemodialysis patients should be warranted. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Grants from National Taiwan University Hospital, Hsinchu Branch.

scholarly journals Sex-specific reference values and determinants of infra-renal abdominal aortic diameter among women and men from general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Zhu ◽  
B Arshi ◽  
M Ikram ◽  
R De Knegt ◽  
M Kavousi
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Reference Values ◽  
Aortic Diameter ◽  
Funding Source ◽  
Men And Women ◽  
Abdominal Aortic

Abstract Introduction Abdominal aortic diameter has shown to be a marker of adverse cardiovascular outcomes. Among the non-aneurysmal populations, studies regarding abdominal aortic diameter normal reference values are sparse. Moreover, data regarding the associations between cardiovascular risk factors and aortic diameter among men and women are limited. Purpose To establish age- and sex-specific distribution of the infra-renal abdominal aortic diameters among non-aneurysmal older adults from the general population and to investigate the associations between cardiovascular risk factors and aortic diameters in men and women. Methods From a population-based cohort, 4032 participants (mean age, 67.2 years; 60.4% women) with infra-renal diameter assessment and without history of cardiovascular disease were included. Mean and quantile values of diameters were calculated in different age groups. Multiple linear regression analysis was used to detect the association of cardiovascular risk factors with diameters in men and women. Results The mean crude diameter was larger in men [mean (SD): 19.5 (2.6) mm] compared to women [17.0 (2.4)mm] but after adjustment for body surface area (BSA), the differences were small. There was a non-linear relationship between age and diameter (p<0.001). After 66 years of age, the increase in diameter with increasing age was attenuated. After age 74 years in women and 71 years in men, the relationship between age and infra-renal aortic diameter was no longer statistically significant (Figure). Waist [standardized β (95% CI): 0.02 (0.0–0.04) in women and 0.03 (0.01–0.06) in men] and diastolic blood pressure [0.04 (0.02–0.05) in women and 0.02 (0.0–0.04) in men] were the risk factors for diameters in both sexes. Body mass index [0.02 (0.01–0.09)], systolic blood pressure [−0.01 (−0.02 to −0.01)], smoking status [0.21 (0.02–0.39)], cholesterol [−0.19 (−0.29 to −0.09)], and lipid-lowering medication [−0.47 (−0.71 to −0.23)] were significantly associated with aortic diameter only in women. Conclusion The differences in the crude abdominal aortic diameter between women and men diminished after taking into account the BSA. The abdominal aortic diameter increased steeply with advancing age and up to 66 years of age. However, after 74 years in women and 71 years in men, the diameter values reached a plateau. We also observed sex differences in the associations of cardiovascular risk factors with abdominal aortic diameter. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE)

Associations of cardiovascular disease and blood pressure with cognition in hemodialysis patients: The Osaka Dialysis Complication Study

2021 ◽  
Author(s):  
Tetsuo Shoji ◽  
Hisako Fujii ◽  
Katsuhito Mori ◽  
Shinya Nakatani ◽  
Yuki Nagata ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Diastolic Pressure ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Diabetic Kidney ◽  
Prior Stroke

Abstract Background Previous studies reported mixed results regarding the contributions of cardiovascular disease (CVD) and blood pressure to cognitive impairment in chronic kidney disease. Methods This was a cross-sectional study in 1213 patients on maintenance hemodialysis from 17 dialysis units in Japan. The main exposures were prior CVD and blood pressure components including systolic (SBP) and diastolic pressure (DBP). The outcome was low cognitive function evaluated with the Modified Mini-Mental State examination (3MS) with a cut-off level of 3MS < 80. Results The median age was 67 years, median duration of dialysis was 71 months, 37% were women, 39% had diabetic kidney disease, and 36% had any pre-existing CVD. Median (interquartile range) of 3MS score was 91 (82 to 97), and 240 patients (20%) had 3MS < 80. Logistic regression analysis showed that 3MS < 80 was associated with the presence of any prior CVD, particularly prior stroke. 3MS < 80 was associated with lower DBP but not with SBP. When patients were stratified by the presence of prior stroke, lower DBP, higher age, and lower education level were factors associated with 3MS < 80 in both subgroups. In the subgroup of patients without prior stroke, diabetic kidney disease was an additional factor associated with 3MS < 80. CVDs other than stroke were not associated with 3MS in either subgroup. Conclusions Prior stroke and lower DBP were associated with 3MS < 80 in hemodialysis patients. These findings support the hypothesis that these vascular factors contribute to low cognitive performance in patients undergoing hemodialysis.

scholarly journals Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

2018 ◽  
Vol 9 (2) ◽  
pp. 69-82 ◽  
Author(s):  
Inkyong Hur ◽  
Yong Kyu Lee ◽  
Kamyar Kalantar-Zadeh ◽  
Yoshitsugu Obi
Keyword(s):  
Blood Pressure ◽  
Precision Medicine ◽  
Kidney Function ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Clinical Aspects ◽  
Patient Centeredness ◽  
Mineral And Bone Disorder ◽  
Term Survival ◽  
Residual Kidney Function

Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemo­dialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.

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