Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Yuliang Zhao; Letian Yang; Shaobin Yu; Stephen Salerno; Yi Li; Tianlei Cui; Ling Zhang; Ping Fu

doi:10.1159/000511295

Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Kidney Dis (Basel). 2021 Sep;7(5):411-424. doi: 10.1159/000511295. Epub 2020 Nov 10.

Authors

Yuliang Zhao^{1

2}, Letian Yang^{1

2}, Shaobin Yu^{1

2}, Stephen Salerno³, Yi Li^{3

4}, Tianlei Cui^{1

2}, Ling Zhang^{1

2}, Ping Fu^{1

2}

Affiliations

¹ Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
² Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
³ Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

Background: The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population.

Methods: Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included.

Results: A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07-1.19; p < 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10-1.22; p < 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05-1.17; p = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06-1.22; p < 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (p = 0.01) and cardiovascular (p = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01-1.17; p = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52-1.42; p = 0.56).

Conclusions: This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).

Keywords: Blood pressure variability; Cardiovascular; Hemodialysis; Mortality; Prognosis.