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Diastolic blood pressure is associated with brain atrophy in hemodialysis patients: A single center case-control

Keren Cohen-Hagai1,2, Feda Fanadka3, Tania Grumberg4

  • 1Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.

Therapeutic Apheresis and Dialysis : Official Peer-Reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
|March 25, 2021
PubMed

Insights

Lower diastolic blood pressure (DBP) is linked to increased brain atrophy (BA) in hemodialysis patients, suggesting cerebral hypoperfusion. This finding advises against aggressive hypertension treatment in this population.

Area of Science:

  • Nephrology
  • Neurology
  • Radiology

Background:

  • Brain atrophy (BA) is common in hemodialysis patients, indicating cerebral damage.
  • Factors like age, hypertension, and diabetes contribute to BA, often present in hemodialysis patients.
  • Cerebral hypoperfusion during hemodialysis may also cause BA, but optimal blood pressure targets are unclear.

Purpose of the Study:

  • To investigate the association between blood pressure (BP) levels and the prevalence/severity of brain atrophy in hemodialysis patients.
  • To determine if lower BP is associated with a higher incidence or greater severity of BA.

Main Methods:

  • Retrospective study of 280 patients undergoing brain CT scans (2015-2017).
  • BA was graded by a blinded neuroradiologist.
  • Hemodialysis patients were compared to age- and sex-matched controls with normal kidney function.

Main Results:

  • Brain atrophy was more prevalent in hemodialysis patients and worsened with age and cardiovascular risk factors.
  • A significant negative correlation was found between diastolic blood pressure (DBP) at dialysis initiation and BA severity.
  • Lower average DBP correlated with increased BA severity in both hemodialysis and non-CKD patients.

Conclusions:

  • Lower DBP is associated with increased brain atrophy, potentially due to cerebral hypoperfusion and ischemia.
  • Findings suggest that over-treatment of hypertension in hemodialysis patients should be reconsidered.

Keywords:
blood pressurebrain atrophydialysishemodialysishypotension

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