Changes in pre-dialysis blood pressure variability in the first year of dialysis associate with mortality in European hemodialysis patients: a retrospective cohort study on behalf of the MONDO Initiative

M.J.E. Dekker*, L.A. Usvyat, C.J.A.M. Konings, J.P. Kooman, B. Canaud, P. Carioni, D. Marcelli, F.M. van der Sande, V. Maheshwari, Y.D. Wang, P. Kotanko, J.G. Raimann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Pre-hemodialysis systolic blood pressure variability (pre-HD SBPV) has been associated with outcomes. The association of a change in pre-HD SBPV over time with outcomes, and predictors of this change, has not yet been studied. Therefore, we studied this in a cohort of 8825 incident hemodialysis (HD) patients from the European Monitoring Dialysis Outcomes Initiative database. Patient level pre-HD SBPV was calculated as the standard deviation of the residuals of a linear regression model of systolic blood pressure (SBP) over time divided by individual mean SBP in the respective time periods. The pre-HD SBPV difference between months 1-6 and 7-12 was used as an indicator of pre-HD SBPV change. The association between pre-HD SBPV change and all-cause mortality in year 2 was analyzed by multivariate Cox models. Predictors of pre-HD SBPV change was determined by logistic regression models. We found the highest pre-HD SBPV tertile, in the first 6 months after initiation of HD, had the highest mortality rates (adjusted HR 1.44 (95% confidence intervals (95% CI): 1.15-1.79)). An increase in pre-HD SBPV between months 1-6 and 7-12 was associated with an increased risk of mortality in year 2 (adjusted HR 1.29 (95% CI: 1.05-1.58)) compared with stable pre-HD SPBV. A pre-HD SBPV increase was associated with female gender, higher mean pre-HD SBP and pulse pressure, and lower HD frequency.
Original languageEnglish
Pages (from-to)437-445
Number of pages9
JournalJournal of Human Hypertension
Issue number5
Early online date9 Jun 2020
Publication statusPublished - May 2021


  • cardiovascular outcomes
  • hypertension
  • kidney
  • lessons
  • prognostic-significance
  • to-visit variability

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