Related Experiment Video
Updated: Aug 31, 2025
A Murine Model of Hemodialysis Access-Related Hand Dysfunction
Published on: May 31, 2022
The association of long-term blood pressure variability with hemodialysis access thrombosis
Mu-Yang Hsieh1,2,3, Chi-Hung Cheng4, Chiu-Hui Chen5
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
Insights
Blood pressure variability (BPV) significantly increases the risk of hemodialysis access thrombosis. Managing BP fluctuations is crucial for preventing these dangerous vascular access events in dialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Access
Background:
- Blood pressure variability (BPV) is a recognized risk factor for cardiovascular events.
- Hemodialysis patients are particularly vulnerable to complications related to blood pressure fluctuations.
- The impact of BPV on hemodialysis access thrombosis requires further investigation.
Purpose of the Study:
- To determine the association between blood pressure variability and the incidence of hemodialysis access thrombosis.
- To identify factors associated with BPV in hemodialysis patients.
- To evaluate the clinical significance of BPV in predicting vascular access events.
Main Methods:
- A cohort of 1,011 prevalent hemodialysis patients was followed for 30 months.
- Blood pressure variability was quantified using the coefficient of variation from 36 consecutive measurements.
- Cox proportional hazards models were employed to assess the risk of access thrombosis associated with BPV.
Main Results:
- Higher blood pressure variability was significantly associated with an increased risk of hemodialysis access thrombosis (HR=1.27 per SD increase).
- Patients in the highest BPV quartile had a 2.45 times greater risk of thrombosis compared to the lowest quartile.
- This association remained significant even after adjusting for average blood pressure, intradialytic hypotension, and comorbidities.
Conclusions:
- Blood pressure fluctuations are a critical independent risk factor for hemodialysis access thrombosis.
- Monitoring and managing BPV may be essential for improving vascular access outcomes in hemodialysis patients.
- These findings highlight the importance of addressing BP variability to prevent access complications.
Background:
Blood pressure variability (BPV) is an important risk factor for cardiovascular events in hemodialysis patients. We sought to determine the impact of BPV on hemodialysis access thrombosis.
Methods:
We enrolled 1,011 prevalent hemodialysis patients from 12 hemodialysis centers since January 2018 and followed them until December 2020. Predialysis blood pressure (BP) was assessed at 12-week intervals. The coefficient of variation derived from 36 consecutive BP measurements was used as the metric for variability. The primary outcome was incident hemodialysis access thrombosis. Linear regression models were used to assess factors associated with BPV at baseline. Kaplan-Meier curves of the time until vascular access events were drawn and log-rank tests were calculated. Cox proportional hazards models were performed to assess the association of BPV with incident vascular access events.
Results:
The average coefficient of variance for systolic BPV was 10.9%. BPV was associated with age, body mass index, mean BP, diabetes, coronary and peripheral artery disease, history of access dysfunction, graft access, intradialytic hypotension, and use of antihypertensive medications. There were 194 access thrombosis events and 451 access stenosis events during a median follow-up period of 30 months. After adjustment of potential confounding factors, BPV was associated with increased risk of access thrombosis [hazard ratio = 1.27, 95% confidence interval (CI), 1.18-1.44, per 1 standard deviation increase in BPV]. The patients in the highest BPV quartile had 2.45 times the risk of thrombosis (CI, 1.62-3.70). The association was independent of average BP, intradialytic hypotension, and comorbidities. Similar trends of association were found in the subgroups analyzed. Comparative analysis using a time-varying variable model and different metrics of BPV showed consistent results.
Conclusion:
Our findings underscored the impact of BP fluctuation on vascular access thrombosis.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:18Hypertension and Regulation of Blood Pressure
01:10Pre-Procedural Guidelines for Assessing Blood Pressure