Early changes in body weight and blood pressure are associated with mortality in incident dialysis patients

Flore Duranton (1) , Yohan Duny (1) , Ilan Szwarc (2) , Sébastien Deleuze (3) , Catherine Rouanet (3) , Isabelle Selcer (3) , François Maurice (3) , Jean-Pierre Rivory (3) , Marie-Françoise Servel (2) , Bernard Jover (4) , Philippe Brunet (5) , Jean-Pierre Daurès (6) , Àngel Argilés (1)

1 UM - Université de Montpellier
2 Nephrologie - Dialyse St-guilhem
3 NephoCare,
4 BC2M - Biocommunication en Cardio-Métabolique
5 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
6 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415

While much research is devoted to identifying novel biomarkers, addressing the prognostic value of routinely measured clinical parameters is of great interest. We studied early blood pressure (BP) and body weight (BW) trajectories in incident haemodialysis patients and their association with all-cause mortality. In a cohort of 357 incident patients, we obtained all records of BP and BW during the first 90 days on dialysis (over 12 800 observations) and analysed trajectories using penalized B-splines and mixed linear regression models. Baseline comorbidities and all-cause mortality (median follow-up: 2.2 years) were obtained from the French Renal Epidemiology and Information Network (REIN) registry, and the association with mortality was assessed by Cox models adjusting for baseline comorbidities. During the initial 90 days on dialysis, there were non-linear decreases in BP and BW, with milder slopes after 15 days [systolic BP (SBP)] or 30 days [diastolic BP (DBP) and BW]. SBP or DBP levels at dialysis initiation and changes in BW occurring in the first month or during the following 2 months were significantly associated with survival. In multivariate models adjusting for baseline comorbidities and prescriptions, higher SBP value and BW slopes were independently associated with a lower risk of mortality. Hazard ratios of mortality and 95% confidence intervals were 0.92 (0.85-0.99) for a 10 mmHg higher SBP and 0.76 (0.66-0.88) for a 1 kg/month higher BW change on Days 30-90. BW loss in the first weeks on dialysis is a strong and independent predictor of mortality. Low BP is also associated with mortality and is probably the consequence of underlying cardiovascular diseases. These early markers appear to be valuable prognostic factors.

Mots clés: incident; body weight; mortality; blood pressure; haemodialysis

Domaines: Sciences du Vivant [q-bio]

Flore Duranton, Yohan Duny, Ilan Szwarc, Sébastien Deleuze, Catherine Rouanet, et al.. Early changes in body weight and blood pressure are associated with mortality in incident dialysis patients. Clinical Kidney Journal, 2016, 9, pp.287-294. ⟨10.1093/ckj/sfv153⟩. ⟨hal-01465920v1⟩