The Impact of Pre-haemodialysis Systolic Blood Pressure on One-year Survival Rate in Chronic Haemodialysis Patients in Medan, Indonesia

Abstract

Introduction: Haemodialysis (HD) patients have higher mortality than the general population. Hypertension is frequent in dialysis, but there is no consensus for an optimal target for blood pressure on HD patients. Systolic Blood Pressure (SBP) levels, which are considered “normal” in the general population, are associated with adverse outcomes in HD patients referred to as “reverse epidemiology.” Aim: To evaluate the impact of pre-haemodialysis Systolic Blood Pressure (pre-SBP) on a one-year survival rate. Materials and Methods: This was a cohort retrospective study done on 133 HD patients in Adam Malik Hospital in January 2017. The patients were divided into two, based on pre-SBP, <130 mmHg, and ≥130 mmHg for each patient. Demographic data, clinical, and laboratory parameters were collected, and the survival rate observed from January 1st, 2017 until December 31th, 2017. For the processing of data, SPSS 22.0 was used. A statistical analysis using Kaplan-Meier survival analysis and conventional Cox regression was performed to evaluate one-year survival. Results: Forty one patients (30.8%) were in category pre-SBP <130 mmHg and 92 patients (69.2%) were in category preSBP ≥130 mmHg. One year mortality rate was 25.6%. There was a statistically significant association between pre-SBP <130 mmHg and one-year mortality. After adjusted with age, gender, HD vintage, and Hb, pre-SBP <130 mmHg had greater mortality with Hazard Ratio (HR) 2.235 (CI: 1.110-4.499, p=0.024) compare to pre-SBP ≥130 mmHg. Conclusion: The relationship between pre-SBP and mortality in HD patients consistently differs from those in the general population. Patients with “low” pre-SBP (<130 mmHg) is associated with greater mortality compared to those with “high” pre-SBP (≥130 mmHg).

Keywords

• hypertension
• kidney disease
• predictor