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NDT Advance Access published online on December 23, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh614
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Nephrol Dial Transplant © ERA-EDTA 2004; all rights reserved
Received June 24, 2004
Accepted September 16, 2004

Original Articles

Orthostatic hypotension at the introductory phase of haemodialysis predicts all-cause mortality

Osamu Sasaki 1, Hajime Nakahama 1*, Satoko Nakamura 1, Fumiki Yoshihara 1, Takashi Inenaga 1, Masayoshi Yoshii 1, Shigeru Kohno 2, and Yuhei Kawano 1

1 Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Osaka, Japan
2 Second Department of Internal Medicine, Nagasaki University, Nagasaki, Japan

* To whom correspondence should be addressed.
Hajime Nakahama, E-mail: hnakaham{at}hsp.ncvc.go.jp



  Abstract

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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