Interdialytic blood pressure variability and cardiovascular events in hemodialysis patients

Abstract

Patients with end-stage renal disease (ESRD) undergoing hemodialysis have higher mortality rates compared not only with general population, but also with patients with diabetes mellitus, cardiovascular disease, or several types of cancer. Cardiovascular mortality is 9-fold higher in hemodialysis patients than age- and sex-matched healthy individuals and, thus, cardiovascular disease is the leading cause of mortality in hemodialysis patients, accounting for 54% of deaths with known causes. To determine the association between BPV and the development of cardiovascular events in hemodialysis patients. This prospective cohort study will be conducted at Ain Shams University Hospitals over a six-month period, focusing on patients with end-stage renal disease who are undergoing regular hemodialysis. The study aims to track and analyze the clinical outcomes and various factors affecting this population, providing valuable insights into the management and prognosis of patients with end-stage renal disease. This study highlights a strong association between blood pressure variability (BPV) and cardiovascular events in hemodialysis patients, revealing that higher BPV is significantly linked to increased risks of fatal and non-fatal myocardial infarction, stroke, and all-cause mortality. The cohort, predominantly male with a mean age of 62.75 years, had a high prevalence of hypertension (78.7%), diabetes (36.2%), and coronary artery disease (27.7%). Most patients were treated with beta-blockers and erythropoietin. A striking 95.7% exhibited non-dipping nocturnal BP patterns, indicating autonomic dysfunction and heightened cardiovascular risk. Systolic BPV, in particular, demonstrated strong predictive value for cardiovascular events (AUC = 0.718), affirming BPV as an independent mortality predictor. While ambulatory blood pressure monitoring (ABPM) was generally well-tolerated, minor side effects such as arm soreness, sleep disruption, and skin irritation were reported, underscoring the need to balance monitoring benefits with patient comfort. This study highlighted the significant association between blood pressure variability (BPV) and cardiovascular events in hemodialysis patients, emphasizing its role as an independent predictor of mortality and adverse outcomes such as myocardial infarction and stroke. The high prevalence of non-dipping blood pressure patterns in this population further underscores the need for continuous monitoring and targeted interventions to stabilize BP fluctuations.