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Changes in pre-dialysis blood pressure variability in the first year of dialysis associate with mortality in European hemodialysis patients: a retrospective cohort study on behalf of the MONDO Initiative


Pre-hemodialysis systolic blood pressure variability (pre-HD SBPV) has been associated with outcomes. The association of a change in pre-HD SBPV over time with outcomes, and predictors of this change, has not yet been studied. Therefore, we studied this in a cohort of 8825 incident hemodialysis (HD) patients from the European Monitoring Dialysis Outcomes Initiative database. Patient level pre-HD SBPV was calculated as the standard deviation of the residuals of a linear regression model of systolic blood pressure (SBP) over time divided by individual mean SBP in the respective time periods. The pre-HD SBPV difference between months 1–6 and 7–12 was used as an indicator of pre-HD SBPV change. The association between pre-HD SBPV change and all-cause mortality in year 2 was analyzed by multivariate Cox models. Predictors of pre-HD SBPV change was determined by logistic regression models. We found the highest pre-HD SBPV tertile, in the first 6 months after initiation of HD, had the highest mortality rates (adjusted HR 1.44 (95% confidence intervals (95% CI): 1.15–1.79)). An increase in pre-HD SBPV between months 1–6 and 7–12 was associated with an increased risk of mortality in year 2 (adjusted HR 1.29 (95% CI: 1.05–1.58)) compared with stable pre-HD SPBV. A pre-HD SBPV increase was associated with female gender, higher mean pre-HD SBP and pulse pressure, and lower HD frequency.

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Correspondence to Marijke J. E. Dekker.

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BC and LAU are employees of Fresenius Medical Care and may hold stock in the company. PK and BC hold stock in Fresenius Medical Care. DM has been an employee of Fresenius Medical Care during the preparation of this paper. MJED, JPK, CJAMK, FMS, VM, YW, and JGR have no conflict of interest.

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Dekker, M.J.E., Usvyat, L.A., Konings, C.J.A.M. et al. Changes in pre-dialysis blood pressure variability in the first year of dialysis associate with mortality in European hemodialysis patients: a retrospective cohort study on behalf of the MONDO Initiative. J Hum Hypertens 35, 437–445 (2021).

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