Faculty Opinions recommendation of Blood pressure variability as an adverse prognostic risk factor in end-stage renal disease.

Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis are susceptible to the development of autonomic dysfunction, which is associated with an increased risk of sudden death. Experimental and clinical evidence suggest a crucial role of autonomic dysfunction for both, the progression of renal disease and for the high rate of cardiovascular events in these patients. In the present study, we evaluated the heart rate variability (HRV), the blood pressure variability (BPV) and the baroreflex sensitivity (BRS) in ESRD patients undergoing hemodialysis and normal controls. Methods: Nine ESRD patients undergoing hemodialysis (mean age 53.4±10.2 years, 4 male) and nine age-matched healthy controls (mean age 52.8±10.2 years, 4 male) were assessed. Non−invasive curves of blood pressure (BP) were recorded continuously (Finometer ®) for 10 minutes, at rest, in the supine position. The heart rate variability (HRV) and systolic blood pressure variability (BPV) were estimated in the time and frequency domain (spectral analysis). The BRS was quantified by alpha index. Statistical analyzes were performed by Student's t test and the results were expressed as mean ± standard deviation. Results: ESRD patients presented lower HRV in time domain than healthy controls (SDNN: 25.8±10.7 vs. 44.6±11.7 ms, p<0.01; VAR NN: 768.3±607.4 vs. 2113.9±1261.6 ms 2 , p=0.01). All frequency domain analyzed indexes, i.e., total power (361.9±297.0 vs. 1227.2±696.3 ms 2 , p<0.01), high-frequency (181.8±128.7 vs. 358.7±179.8 ms 2 , p=0.047), low-frequency (55.1±44.2 vs. 444.6±389.9 ms 2 , p=0.02) and very-low-frequency (72.5±75.1 vs. 279.2±119.5 ms 2 , p<0.01) of HRV were lower in ESRD patients. The BPV was higher in ESRD patients when compared to controls (VAR PAS: 98.4±72.0 vs. 35.4±21.4 ms 2 , p=0.03) and BRS was lower in ESRD patients (alpha index: 4.34±3.05 vs. 7.56±2.50 ms/mmHg, p<0.02). Conclusion: ESRD patients undergoing hemodialysis presents reduced HRV, increase in BPV and reduced baroreflex sensitivity. These impairments may be associated with mortality in ESRD.

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Pre-end-stage renal disease visit-to-visit systolic blood pressure variability and post-end-stage renal disease mortality in incident dialysis patients

Journal of Hypertension ◽

10.1097/hjh.0000000000001376 ◽

2017 ◽

Vol 35 (9) ◽

pp. 1816-1824 ◽

Cited By ~ 6

Author(s):

Keiichi Sumida ◽

Miklos Z. Molnar ◽

Praveen K. Potukuchi ◽

Fridtjof Thomas ◽

Jun Ling Lu ◽

...

Keyword(s):

Blood Pressure ◽

Renal Disease ◽

Systolic Blood Pressure ◽

End Stage Renal Disease ◽

Blood Pressure Variability ◽

Dialysis Patients ◽

Disease Mortality ◽

Systolic Blood Pressure Variability ◽

Stage Renal Disease ◽

End Stage

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MO104RISK OF END-STAGE RENAL DISEASE: PREDICTION USING CUMULATIVE NUMBER OF HYPERTENSION DIAGNOSES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab106.0013 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Chang Seong Kim ◽

Hong Sang Choi ◽

Tae Ryom Oh ◽

Eun hui Bae ◽

Soo Wan Kim

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Renal Disease ◽

End Stage Renal Disease ◽

Clinical Population ◽

Cumulative Number ◽

Diastolic Hypertension ◽

History Of ◽

Stage Renal Disease ◽

End Stage

Abstract Background and Aims Hypertension is the leading risk factor for end-stage renal disease (ESRD). However, the association between repeated measurements of high blood pressure and ESRD is not well-established. This study investigated whether the cumulative number of diagnoses of hypertension is a substantial risk factor for ESRD. Method The incidence of ESRD among 2,144,801 participants, identified from the Korean National Health Insurance Service database, who did not have a history of antihypertensive therapy and had documented blood pressure assessments for 4 consecutive years was determined retrospectively. Data were extracted from the database where events of hypertension were defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Results Over a median follow-up of 7.2 years, ESRD was identified in 1758 of the 2,144,801 participants. In a multivariable Cox model adjusted for age, sex, smoking, alcohol consumption, exercise, and history of diabetes and chronic kidney disease, a positive dose-dependent relationship between the cumulative number of diagnoses of hypertension and ESRD was found (adjusted hazard ratio for ESRD, 2.70 in 4 cumulative number of diagnoses of hypertension compared to no history of hypertension). This association was maintained for the cumulative number of diagnoses of both systolic and diastolic hypertension. Conclusion The cumulative number of diagnoses of systolic or diastolic hypertension increases the risk of ESRD. Therefore, preventive treatment to avoid repetitive events of systolic or diastolic hypertension may be important to lower the risk of ESRD in this clinical population.

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