Utilizing long-term predialysis blood pressure change to predict all-cause mortality in patients undergoing...

To investigate the association between long-term predialysis blood pressure (BP) change and all-cause mortality in patients on maintenance hemodialysis (MHD).

We retrospectively included patients receiving MHD from 1 January 2019 to 31 December 2024. The regression slope was used to estimate BP temporal change with dialysis vintage. The regression slope was divided into three groups: small slope (absolute number < 0.05), large increasing slope (≥ 0.05 group), and large decreasing slope (≤-0.05 group). If the regression slope was positive, we defined the trend of BP was increasing. Conversely, BP showed a decreasing trend. Survival analysis was performed using Cox proportional hazards regression models.

A total of 812 patients with 317 894 predialysis BP measurements were included in the final cohort. The mean predialysis BP was 146.44/85.66 mmHg. During the study period, 161 deaths occurred. In multivariable Cox regression analysis, patients with a small slope of SBP or DBP demonstrated the highest survival rate. Both patients with a large increasing slope or a large decreasing slope had significantly higher mortality ( P  < 0.001). Notably, a BP change direction (an increasing or decreasing trend) was not associated with mortality. The association between long-term predialysis BP slope and mortality was independent of age at first hemodialysis, diabetic nephropathy, coronary heart disease, pulse rate, antihypertensive drug, and ultrafiltration. This association was consistent for both SBP and DBP.

A stable trend of long-term predialysis BP was associated with a favorable survival outcome. Both SBP and DBP influence clinical outcomes.