Long-Term Peridialytic Blood Pressure Patterns in Patients Treated by Hemodialysis and Hemodiafiltration

Paul Rootjes (1) , Camiel de Roij van Zuijdewijn (1) , Muriel Grooteman (1) , Michiel Bots (2) , Bernard Canaud (2) , Peter Blankestijn (3) , Frans van Ittersum (4) , Francisco Maduell (5) , Marion Morena (2, 6) , Sanne Peters (7) , Andrew Davenport (8) , Robin Vernooij (9, 10) , Menso Nubé (3)

1 Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands.
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
4 Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands.
5 Department of Nephrology, Hospital Clinic, Barcelona, Spain.
6 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
7 The George Institute for Global Health, University of Oxford, Oxford, UK
8 UCL - University College of London [London]
9 Universiteit Utrecht / Utrecht University [Utrecht]
10 Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands

Online postdilution hemodiafiltration (HDF) is associated with a lower all-cause and cardiovascular mortality than hemodialysis (HD). This may depend on a superior peridialytic (pre- and postdialysis, and the difference between these 2 parameters) hemodynamic profile. Introduction: Online postdilution hemodiafiltration (HDF) is associated with a lower all-cause and cardiovascular mortality than hemodialysis (HD). This may depend on a superior peridialytic (pre- and postdialysis, and the difference between these 2 parameters) hemodynamic profile. Methods: In this retrospective cohort analysis of individual participant data (IPD) from 3 randomized controlled trials (RCTs) (n = 2011), the effect of HDF and HD on 2-year peridialytic blood pressure (BP) patterns was assessed. Long-term peridialytic systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), as well as the deltas (post- minus predialytic) were assessed in the total group of patients. Thereafter, these variables were compared between patients on HD and HDF, and in the latter group between quartiles of convection volume. Results: Mean pre- and postdialysis SBP, DBP, and MAP declined significantly during follow-up (predialytic: SBP -2.16 mm Hg, DBP -2.88 mm Hg, MAP -2.64 mm Hg), PP increased (predialytic 0.96 mm Hg). Peridialytic deltas remained unaltered. Differences between the 2 modalities, or between quartiles of convection volume were not observed. BP changes were independent of various baseline characteristics, including the decline in body weight over time. Conclusion: We speculate that the combination of a decreasing SBP and an increasing PP may be the clinical sequelae of a worsening cardiovascular system. Because especially HDF with a high convection volume has been associated with a beneficial effect on survival, our study does not support the view that superior peridialytic BP control contributes to this effect.

Mots clés: peridialytic; blood pressure; hemodiafiltration; hemodialysis; individual participant data

Domaines: Sciences du Vivant [q-bio]

Paul Rootjes, Camiel de Roij van Zuijdewijn, Muriel Grooteman, Michiel Bots, Bernard Canaud, et al.. Long-Term Peridialytic Blood Pressure Patterns in Patients Treated by Hemodialysis and Hemodiafiltration. Kidney International Reports, 2020, 5 (4), pp.503-510. ⟨10.1016/j.ekir.2020.01.007⟩. ⟨hal-02540522⟩