NDT Advance Access originally published online on December 23, 2004
Nephrology Dialysis Transplantation 2005 20(2):377-381; doi:10.1093/ndt/gfh614
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Nephrol Dial Transplant Vol. 20 No. 2 © ERA–EDTA 2004; all rights reserved
Original Article
Orthostatic hypotension at the introductory phase of haemodialysis predicts all-cause mortality
1 Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Osaka and 2 Second Department of Internal Medicine, Nagasaki University, Nagasaki, Japan
Correspondence and offprint requests to: Hajime Nakahama, Division of Hypertension and Nephrology, National Cardiovascular Center, Fujishirodai 5-7-1, Suita 565-8565, Osaka, Japan. Email: hnakaham{at}hsp.ncvc.go.jp
Background. Since the predictive value of orthostatic hypotension (OH) at the introductory phase of haemodialysis (HD) is unknown, we examined the association between OH and all-cause death in patients who started HD between 1987 and 2001.
Methods. More than three consecutive blood pressure measurements before HD treatments (pre-HD BP) were made on each of 304 patients who had recently been started on HD and were in a stable condition. OH was defined as a drop in systolic BP of >20 mmHg or in diastolic BP of >10 mmHg after standing.
Results. Of 304 patients, 42% had OH. OH was significantly associated with pre-HD supine systolic BP; its severity was significantly associated with a past history of cerebrovascular disease and pre-HD supine systolic BP. During a mean follow-up of 4.0±3.0 years (range 0.1–13.2 years), 136 deaths were recorded. A multivariate Cox proportional hazards model analysis demonstrated that OH and a past history of cerebrovascular disease were independent predictors of all-cause death. The comparison by Kaplan–Meier analysis of the overall survival of patients with and without OH was significant.
Conclusions. Our findings validate OH at the introductory phase of HD as a novel independent predictor of all-cause mortality among HD patients.
Keywords: haemodialysis; orthostatic hypotension; survival rate
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