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Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study

Hypertension Research volume 44, pages 1417–1427 (2021)Cite this article

Abstract

The risk factors for intradialytic systolic blood pressure decline remain poorly understood. We aimed to identify clinical and laboratory predictors of the intradialytic systolic blood pressure decline, considering its seasonal variation. In a retrospective cohort of 47,219 hemodialysis sessions of 307 patients undergoing hemodialysis over one year in three dialysis clinics, the seasonal variation and the predictors of intradialytic systolic blood pressure decline (predialysis systolic blood pressure––nadir intradialytic systolic blood pressure) were assessed using cosinor analysis and linear mixed models adjusted for baseline or monthly hemodialysis-related variables, respectively. The intradialytic systolic blood pressure decline was greatest and least in the winter and summer, respectively, showing a clear seasonal pattern. In both models adjusted for baseline and monthly hemodialysis-related parameters, calcium channel blocker use was associated with a smaller decline (−4.58 [95% confidence interval (CI), −5.84 to −3.33], P < 0.001; −3.66 [95% CI, −5.69 to −1.64], P < 0.001) and α blocker use, with a greater decline (3.25 [95% CI, 1.53–4.97], P < 0.001; 3.57 [95% CI, 1.08–6.06], P = 0.005). Baseline and monthly serum phosphorus levels were positively correlated with the decline (1.55 [95% CI, 0.30–2.80], P = 0.02; 0.59 [95% CI, 0.16–1.00], P = 0.007), and baseline and monthly normalized protein catabolic rates were inversely correlated (respectively, −22.41 [95% CI, −33.53 to −11.28], P < 0.001; 9.65 [95% CI, 4.60–14.70], P < 0.001). In conclusion, calcium channel blocker use, α blocker avoidance, and serum phosphorus-lowering therapy may attenuate the intradialytic systolic blood pressure decline and should be investigated in prospective trials.

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Acknowledgements

The authors thank all participants in this research project. The authors acknowledge Dr. Shigeaki Ohtsuki for technical and statistical assistance.

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Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Kiyotaka Uchiyama, Ei Kusahana, Takashin Nakayama, Naoki Washida & Hiroshi Itoh

  2. Shibagaki Dialysis Clinic Jiyugaoka, Tokyo, Japan

    Keigo Shibagaki

  3. Department of Nephrology, Tokyo Shinagawa Hospital, Tokyo, Japan

    Akane Yanai

  4. Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan

    Kohkichi Morimoto

  5. Department of Nephrology, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan

    Naoki Washida

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  1. Kiyotaka Uchiyama
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Correspondence to Kiyotaka Uchiyama.

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Uchiyama, K., Shibagaki, K., Yanai, A. et al. Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study. Hypertens Res 44, 1417–1427 (2021). https://doi.org/10.1038/s41440-021-00714-1

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