The effect of pre- and post-dialysis blood pressure and its variations during the hemodialysis procedure on the survival of patients in a 5-year cohort study conducted in real-life clinical setting

V.Yu. Shylo, I.Yu. Drachev

1 SBEI HPE "Moscow State Medical Stomatological University n.a. A.I. Evdokimov" of RMH; Moscow, Russia; 2 FSBEI HE "Tver State Medical University" of RMH; Tver, Russia; 3 B. Braun Avitum Russland Clinics, Dialysis Center; Moscow, Russia

Aim. To evaluate the effect of pre- and postdialysis hypertension, normo- and hypotension, as well as intradialysis changes in blood pressure (BP) on the survival of patients receiving program hemodialysis (HD).

Material and methods. The study included 3723 patients who were on program hemodialysis at the dialysis centers of the B. Brown Avitum Russland network, and who started hemodialysis treatment from 2011 to 2016. BP was recorded before and after the dialysis procedure, and at least every hour during the dialysis procedure. The parameters of the averaged blood pressure over the follow-up period were analyzed.

Results. The averaged mean pre-dialysis blood pressure was 140±15.8 and 84±9.8 mm Hg, postdialysis – 134.9±15.2 and 82.4±15.2. Three-year active survival rate of patients from the moment of inclusion in the study was 86%, a five-year survival rate – 78%. According to the Kaplan-Meier statistical model, survival depended on the values of pre- and post-dialysis blood pressure. Before the dialisis session, the subgroup of the upper quartile of systolic blood pressure (SBP, P <0.0001), and the subgroup of the lower quartile of diastolic blood pressure (DBP, p=0.001) showed the worst survival rate with high statistical reliability. Evaluation of the relationship between blood pressure and survival in the Cox regression model showed a significant effect of low predialysis DBP; the lowest survival rate after the dialysis session was observed in patients with a decrease in SBP <126 mm Hg. Evaluation of intra-dialysis variations in blood pressure revealed statistical significancant intensive decrease in SBP during the hemodialysis procedure by more than 20 and 30 mm Hg. It was found that high ultrafiltration (UF) rates lead to a significant decrease in SBP after a dialysis session. There was also a weak but significant inverse correlation between the UV rates and the change in SBP during the procedure.

Conclusion. Low predialysis DBP levels and elevated SBP, as well as a decrease in SBP after dialysis procedure below optimal values have a significant effect on the survival of patients with CKD-5D. The effect of changes in blood pressure during the dialysis session on survival was established: an intra-dialysis increase in SBP by more than 10 mm Hg and a fall in SBP by 20 mm Hg and below statistically significantly worsen the prognosis of patients on the program hemodialysis. Association of high ultrafiltration rates with fall of blood pressure at the end of the HD procedure was demonstrated.

About the Autors

Shilo V.Yu. – PhD in Medical Science, Associate Professor at the Department of Nephrology FPGPE SBEI HPE "MSMSU n.a. A.I. Evdokimov" of RMH, medical director of
the network of B. Braun Avitum dialysis clinics in the Russian Federation; Moscow, Russia. E-mail:
Drachev I.Yu. - Postgraduate Student at the Department of Faculty Therapy FSBEI HE TSMU of RMH, chief resident at the hemodialysis department MCHTP; Moscow,

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