Pre-dialysis fluid status, pre-dialysis systolic blood pressure and outcome in prevalent haemodialysis patients: results of an international cohort study on behalf of the MONDO initiative

Marijke Dekker*, Constantijn Konings, Bernard Canaud, Paola Carioni, Adrian Guinsburg, Magdalena Madero, Jeroen van der Net, Jochen Raimann, Frank van der Sande, Stefano Stuard, Len Usvyat, Yuedong Wang, Xiaoqi Xu, Peter Kotanko, Jeroen Kooman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Web of Science)


Background. Pre-dialysis fluid overload (FO) associates with mortality and causes elevated pre-dialysis systolic blood pressure (pre-SBP). However, low pre-SBP is associated with increased mortality in haemodialysis patients. The objective of this study was to investigate the interaction between pre-dialysis fluid status (FS) and pre-SBP in association withmortality. Methods. We included all patients from the international Monitoring Dialysis Outcome Initiative (MONDO) database with a pre-dialysis multifrequency bioimpedance spectroscopy measurement in the year 2011. We used all parameters available during a 90-day baseline period. All-cause mortality was recorded during 1-year follow-up. Associations with outcome were assessed with Cox models and a smoothing spline Cox analysis. Results. We included 8883 patients. In patients with predialysis FO (> thorn1.1 tothorn2.5 L), pre-SBP < 110 mmHg was associated with an increased risk of death {hazard ratio (HR) 1.52 [95% confidence interval (CI) 1.06-2.17]}. An increased risk of death was also associated with pre-dialysis fluid depletion (FD;<-1.1 L) combined with a pre-SBP< 140 mmHg. In normovolemic (NV) patients, low pre-SBP< 110 mmHg was associated with better survival [HR 0.46 (95% CI 0.230.91)]. Also, post-dialysis FD associated with a survival benefit. Results were similar when inflammation was present. Only high ultrafiltration rate could not explain the higher mortality rates observed. Conclusion. The relation between pre-SBP and outcome is dependent on pre-dialysis FS. Low pre-SBP appears to be disadvantageous in patients with FO or FD, but not in NV patients. Post-dialysis FD was found to associate with improved survival. Therefore, we suggest interpreting pre- SBP levels in the context of FS and not as an isolated marker.
Original languageEnglish
Pages (from-to)2027-2034
Number of pages8
JournalNephrology Dialysis Transplantation
Issue number11
Publication statusPublished - 1 Nov 2018


  • fluid overload
  • haemodialysis
  • pre-dialysis blood pressure
  • pre-dialysis fluid status
  • survival

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