| 1st author Year of publication Reference | Aim of the study | Study design Method of BP measurement Follow-up period | Number Population (Country, KRT modality) | Primary analysis | Results/Conclusion |
|---|---|---|---|---|---|
| Agarwal, 2010 (4) | To evaluate the presence, strength, and shape of the relationship between BP measured using different modalities (HBPM, ABPM, dialysis unit) and all-cause mortality among HD patients | Prospective cohort (1) HBPM: 3x/day for 1 week using validated device (2) ABPM: 44 hours starting after 1st or mid-week HD session (3) HD unit measurements: average of 6 ‘usual’ (i.e. non-standardized) pre- and post-HD readings Median FU 2.4 years | 326 United States HD (N.B. Majority were African American & those with chronic AF were excluded) | Association between BP and all-cause mortality | (1) W-shaped relationship between ambulatory and home SBP and all-cause mortality, including following adjustment for CV risk factors (age, gender, ethnicity, DM, pre-existing CV disease, dialysis vintage) (2) Ranges of SBP associated with lowest mortality risk were 110-120 mmHg for ambulatory BP and 120-130 for home BP (3) No relationship between DBP and outcomes No relationship between HD unit ‘usual’ BP readings and outcomes |
| Alborzi, 2007 (11) | To evaluate the presence, strength, and shape of relationship between BP using various modalities (HBPM, ABPM and dialysis unit ‘usual’ and standardized) and CV and ACM in HD patients | Prospective cohort (1) HBPM: 3x/day for 1 week using validated device (2) ABPM: 44 hours starting after 1st or mid-week HD session (3) HD unit ‘usual’: average of 6 ‘usual’ (i.e. non-standardized) pre- and post-HD readings (4) HD unit: ‘standardized’: 3 readings pre- & post-HD taken by research nurse after 5 mins rest; averaged over 6 HD sessions Median FU 2 years | 150 United States HD (Similar population to Agarwal 2010; those with chronic AF were excluded) | Association between BP and all-cause mortality A ‘secondary focus’ was associated between BP and CV death | (1) Linear relationship between increasing home (p=0.05 for trend) and ambulatory (p=0.011) BP expressed as quartiles and ACM (2) No relationship between usual or standardized HD unit measurements and ACM Only 4th quartile of ambulatory BP (SBP >145 mmHg) was associated with significantly higher mortality compared to 1st (reference) quartile (<113.5 mmHg), HR 2.52 (95% CI 1.03 to 6.19). No quartile of home BP was significantly different to the referent. |
| Bansal, 2015 (22) | To compare association between SBP and mortality between (1) HD unit BP readings; and (2) BP readings taken outside of HD unit | Prospective cohort (1) Non-standardized pre-HD BP (mean of 1 weeks readings) (2) Standardized out-of-unit SBP (mean of 3 resting seated readings) Mean FU 2.72 years (cohort 1) & 2.83 years (cohort 2) | 403 (HD unit SBP m’ment) 326 (Out-of-unit SBP m’ment) United States HD | Association between SBP and mortality | (1) Non-linear (U-shaped) association between HD-unit SBP and mortality Linear association between out-of-HD unit SBP and mortality – mortality increases by HR 1.26 (95% CI 1.13-1.39) per 10 mmHg increase in SBP |
| Bansal, 2017 (5) | To compare association between SBP, DBP and PP and CV events between (1) HD unit BP readings; and (2) BP readings taken outside of HD unit | Prospective cohort (1) Non-standardized pre-HD BP (mean of 1 week readings) (2) Standardized out-of-unit SBP (mean of 3 resting seated readings) Mean FU 2.72 years | 377 United States HD | Association between SBP and CV events | (1) Non-linear (U-shaped) association between HD-unit SBP and risk of CV events, with nadir between 150 and 170 mmHg (2) Linear direct association between out-of-HD unit SBP and CV events; fully adjusted HR for CV events was 2.14 (95% CI 1.17-3.90) for SBP ≥128 mmHg compared to SBP ≤112 mmHg (HR for 113-127 mmHg was 1.33, 95% CI 0.71-2.5) |
| De Lima, 2023 (36) | To clarify the value of BP, measured at the interdialytic period, as a predictor of outcomes in an HD population | Retrospective cohort Average of 2 BP readings recorded using a calibrated aneroid sphygmomanometer, with the patient in a seated position, taken mid-week, between 2 consecutive dialysis sessions. Median FU 2.58 years | 2,672 Brazil HD | Association between BP and (i) all-cause mortality (ii) CV events | (1) Compared with the reference category of SBP ≥ 171 mmHg, the incidence of CV events was reduced in those with SBP 101-110 (HR 0.65, 95% CI 0.46-0.90), 111-120 (HR 0.66, CI 0.49-0.89), 121-130 (HR 0.75, CI 0.57-0.98), and 131-140 mmHg (HR 0.76, CI 0.6-0.97) When analysed by percentiles of BP, SBP 130 mmHg was associated with reduced risk of CV events (HR 0.75, CI 0.64-0.88, p=0.001) but not reduced mortality (HR 0.89, CI 0.78-1.01, p=0.077) compared to reference 170 mmHg. |
| Hannedouche, 2016 (29) | To analyse associations between pre-dialysis SBP, DBP, and PP with all-cause mortality, CV mortality, and nonfatal CV endpoints | Prospective cohort Usual (non-standardized) pre-HD supine BP Median FU 1.5 years | 9,333 France HD | Association between pre-HD SBP, DBP, PP and all-cause mortality, CV mortality & non-fatal CV events | Non-linear (U-shaped) association between SBP and all-cause mortality and both SBP and DBP and CV mortality Lowest HR for all-cause mortality was 165 mmHg (no lower limit for DBP as L-shaped relationship) For CV mortality, nadir risk was found at 157/90 mmHg In time varying component adjusted Cox model SBP had predictive power for stroke HR 1.15 (95% CI 1.07-1.23) for each 10 mmHg increase Analysis by presence/absence of prior CV disease, use of antihypertensive medication or whether prevalent or incident patient doesn’t change nature of relationship |
| Hara, 2018 (191) | To clarify the association between pre-dialysis BP and mortality and morbidity in HD patients; in addition, to explore BP at which the outcomes risk was at its lowest | Prospective cohort Usual (non-standardized) pre-HD supine BP at baseline FU for 4 years | 3,436 Japan HD | Association between pre-HD SBP & DBP and all-cause & CV mortality | SBP of 152 mmHg and DBP of 68 mmHg were associated with lowest risk of all-cause mortality SBP of 143 mmHg was associated with lowest risk of CV events |
| Jhee, 2018 (32) | To investigate the optimal BP target and the effect of confounding factors on outcomes in patients undergoing prevalent dialysis | Prospective cohort Pre-dialysis sitting BP (unclear whether standardized or not) Median FU 4.5 years | 2,299 Korea HD (59.9%) & PD (40.1%) | Association between pre-dialysis SBP and all-cause mortality | Non-linear (U-shaped) association between SBP and all-cause mortality in HD patients; similar, non-significant, association observed in PD patients SBP <110 and ≥170 mmHg associated with increased risk of all-cause mortality (SBP <110 mmHg: HR 1.68, 95% CI 1.14-2.49; SBP ≥170 mmHg: HR 1.63, 95% CI 1.1-2.42) |
| Mayer, 2018 (34) | To investigate the nonlinear association between ambulatory BP and mortality in an HD cohort. | Prospective cohort ABPM applied over 24 period starting prior to a mid-week HD session FU 3.13 years | 344 Germany HD | Association between ambulatory SBP and all-cause and CV mortality | Non-linear (U-shaped) association between SBP & PP and all-cause & CV mortality When analysed by presence (30.5% of whole cohort) or absence of AF and/or heart failure, a negative linear association between both SBP and PP with ACM and CV mortality was found. Conversely, a positive linear association between SBP and PP and ACM and CV mortality was observed in those without CV co-morbidity. |
| Miskulin, 2018 (26) | To assess feasibility of an RCT in HD patients randomised to a standardized pre-dialysis SBP of 110–140 mmHg (intensive arm) or 155–165 mmHg (standard arm). | Pilot randomized control Standardized pre-HD BP “in accordance with AHA guidelines” FU for 365 days | 126 United States HD | Primary outcome: assess feasibility of study. Secondary outcome: assess change in LVM. | The incidence rate ratios for intensive vs standard arm were 1.18 (0.40 to 3.33), 1.61 (0.87 to 2.97), and 3.09 (0.96 to 8.78) for major adverse cardiovascular events, hospitalisations, and vascular access thrombosis, respectively. The intensive and standard arms had similar median changes in LVM of −0.84 (−17.1 to 10.0) g and 1.4 (−11.6 to 10.4) g, respectively. |
| Myers, 2010 (33) | To examine whether age, race, and diabetes status affect the association between pre-dialysis SBP and mortality | Retrospective cohort Usual (non-standardized) pre-dialysis BP Median FU 1.5 years | 16,283 United States HD | Association between pre-dialysis BP and PP and all-cause mortality | 1) In those >50 years old, SBP <140 (and not SBP >160) mmHg was associated with increased mortality; conversely, in those <50 years old, only SBP >160 (and not SBP <140) mmHg was associated with increased mortality. Higher mortality in those with diabetes (vs. those without) was restricted to those who also had SBP <140 mmHg; in those with SBP >140 mmHg, the association with mortality was not influenced by diabetes status. |
| Park, 2013 (192) | Retrospective cohort Usual (non-standardized) pre- and post-HD BP, averaged over all sessions (~39) in a quarter Median FU 2.2 years | 113,255 United States HD | Association between ΔSBP & DBP during HD and all-cause mortality | Non-linear (U-shaped) association between ΔSBP (& DBP) and ACM & CV mortality, including after adjustment for case-mix and malnutrition-cachexia syndrome: -30 and >0 mmHg associated w increased mortality; nadir risk/greatest survival associated with -14/-6 mmHg (HR 0.92, 95% CI 0.91-0.93; 0.93, 0.91-0.94 for ΔSBP & DBP respectively). Relationship persists at all levels of pre-HD BP, except <120 mmHg (FIG 3) Relationship not modified by UF volume (as % of doy weight) or HD session time (FIG 4) |
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| Robinson, 2012 (28) | Analysis of association between pre-HD SBP and mortality by Cox regression adjusted for patient & facility-level characteristics, as a means to lessen potential bias due to unmeasured confounders affecting SBP and mortality. | Retrospective cohort (using DOPPS data) Usual (non-standardized) pre-HD BP (median of 1 weeks data in DOPPS wave 1 & 2; most recent [single] reading in DOPPS wave 3) Mean FU 1.7 years | 24,525 Multiple countries HD | Retrospective facility & patient level analysis of BP levels & association with all-cause mortality | In fully adjusted multivariable models: At patient level: compared to reference category of 130-139 mmHg, all-cause mortality increased for 110-119 mmHg (HR 1.14, CI 1.01-1.28), 120-129 mmHg (HR 1.11, CI 1-1.23) and decreased for SBP 150-159 mmHg (HR 0.9, CI 0.91-0.99) At facility level: Compared to 130-159 mmHg, all-cause mortality increased for 110-129mmHg (HR 1.13, CI 1.05-1.21) and ≥160 (HR 1.16, CI 1.1-1.23) For post-HD BP lowest risk is (facility level) 120-139 mmHg (see figure 7B) |
| Shafi, 2014 (35) | To test the hypothesis that stratification by serum biomarker (BM) levels may change the association between predialysis SBP and outcomes in HD patients | Prospective cohort Usual (non-standardized) pre-HD sitting BP Median FU 3.1 years | 446 United States HD | Relationship between pre-HD BP and all-cause & CV mortality and CV events, stratified by levels of BMs cardian troponin I and NT-proBNP | High BM levels associated with worse survival at 2.4 years (vs 3.5 yrs in low BM group). Those in high BM group had more overt CV disease (atherosclerotic and heart failure). In low BM group, there was linear increase in all-cause with pre-HD SBP >140 mmHg; no evidence of increase in all-cause mortality at low BP. HR for all-cause mortality was 1.07 (95% CI 1.01-1.14) for each 10 mmHg rise increase in SBP. In high BM group, no relationship between SBP and all-cause mortality existed at high or low BP |
| Xie, 2020 (38) | To explore an optimal target of BP for the PD patient population | Prospective cohort Usual clinic BP (no detail given) averaged over the first 3 months after the initiation of PD; median number of BP measurements contributed by each patient was 4 [interquartile range 3–4] Median FU 2.98 years | 7,335 China PD | Relationship between BP (as detailed) and (i) all-cause mortality (ii) CV mortality | Non-linear (U-shaped) relationship between SBP and all-cause and CV mortality (1) Compared to reference SBP tertile of 119-141 mmHg, HR for all-cause mortality was 1.38 (95% CI 1.12-1.69) for SBP <119 mmHg and 1.2 (CI 1.07-1.35) for BP >141 mmHg For same tertiles, HR for CV mortality were 1.4 (CI 1.02-1.93) and 1.3 (CI 1.08-1.56) |
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