Long-Term Peri-Dialytic Blood Pressure Patterns In Patients Treated By Hemodialysis And Hemodiafiltration

Abstract Introduction Online post-dilution hemodiafiltration is associated with a lower all-cause and cardiovascular mortality than hemodialysis. This may depend on a superior peri-dialytic (pre- and post-dialysis, and the difference between these two parameters) hemodynamical profile. Methods n this retrospective cohort analysis of individual participant data from three randomized controlled trials (n=2011), the effect of hemodiafiltration and hemodialysis on two-year peri-dialytic blood pressure patterns was assessed. Long-term peri-dialytic systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse pressure, as well as the deltas (post- minus pre-dialytic) were assessed in the total group of patients. Thereafter, these variables were compared between patients on hemodialysis and hemodiafiltration, and in the latter group between quartiles of convection volume. Results Mean pre- and post-dialysis systolic-, diastolic- and mean arterial blood pressure declined significantly during follow-up (pre-dialytic: systolic blood pressure -2.16 mmHg, diastolic blood pressure -2.88 mmHg, mean arterial pressure -2.64 mmHg), pulse pressure increased (pre-dialytic 0.96 mmHg). Peri-dialytic deltas remained unaltered. Differences between the two modalities, or between quartiles of convection volume were not observed. Blood pressures changes were independent of various baseline characteristics, including the decline in body weight over time. Conclusion e speculate that the combination of a decreasing systolic blood pressure and an increasing pulse pressure may be the clinical sequelae of a worsening cardiovascular system. Since especially hemodiafiltration with a high convection volume has been associated with a beneficial effect on survival, our study does not support the view that superior peri-dialytic blood pressure control contributes to this effect.