Blood Pressure Variability Among Chronic Dialysis Patients
Blood Pressure Variability Among Chronic Dialysis Patients
Purpose of review This review focuses on recent evidence linking blood pressure variability (BPV) to adverse clinical outcomes in the chronic hemodialysis patient population.
Recent findings BPV is an increasingly recognized poor prognostic factor in the general population. A growing body of evidence suggests that both short-term and long-term BPV are associated with adverse events among chronic dialysis patients. Over the last 18 months, several studies have linked long-term BPV (considered dialysis treatment to dialysis treatment) to all-cause and cardiovascular morbidity and mortality. Similar results have been demonstrated for short-term (considered as intradialytic) BPV and clinical outcomes. Further studies substantiating these findings and examining potential BPV mitigation strategies are needed. Additionally, a BPV metric that is easily calculated and tracked in the clinical setting is necessary before BPV can become a routine component of clinical monitoring.
Summary Recent observational data demonstrate an association between short-term and long-term BPV and adverse outcomes among chronic hemodialysis patients. Further research is needed to identify strategies that mitigate this risk and to translate these findings into clinical practice.
Blood pressure variability (BPV) is an increasingly recognized risk factor for morbidity and mortality in the general population as well as in subpopulations such as in patients with diabetes, hypertension, and rheumatoid arthritis. BPV has been linked to the progression of chronic kidney disease, increased left ventricular mass, stroke, and mortality. Although the pathophysiology of BPV-induced risk is not fully elucidated, it likely relates to end-organ damage from blood pressure (BP) fluctuations and associated tissue hypoxia and vascular shear stress. Superimposed on a stiff underlying vasculature common among patients with kidney disease, and amplified by osmolar and fluid shifts inherent to the hemodialysis procedure, BPV may be particularly hazardous to hemodialysis patients. This review will provide an overview of BPV analytical issues, report recent advances in the field, and consider future directions for research and clinical application.
Abstract and Introduction
Abstract
Purpose of review This review focuses on recent evidence linking blood pressure variability (BPV) to adverse clinical outcomes in the chronic hemodialysis patient population.
Recent findings BPV is an increasingly recognized poor prognostic factor in the general population. A growing body of evidence suggests that both short-term and long-term BPV are associated with adverse events among chronic dialysis patients. Over the last 18 months, several studies have linked long-term BPV (considered dialysis treatment to dialysis treatment) to all-cause and cardiovascular morbidity and mortality. Similar results have been demonstrated for short-term (considered as intradialytic) BPV and clinical outcomes. Further studies substantiating these findings and examining potential BPV mitigation strategies are needed. Additionally, a BPV metric that is easily calculated and tracked in the clinical setting is necessary before BPV can become a routine component of clinical monitoring.
Summary Recent observational data demonstrate an association between short-term and long-term BPV and adverse outcomes among chronic hemodialysis patients. Further research is needed to identify strategies that mitigate this risk and to translate these findings into clinical practice.
Introduction
Blood pressure variability (BPV) is an increasingly recognized risk factor for morbidity and mortality in the general population as well as in subpopulations such as in patients with diabetes, hypertension, and rheumatoid arthritis. BPV has been linked to the progression of chronic kidney disease, increased left ventricular mass, stroke, and mortality. Although the pathophysiology of BPV-induced risk is not fully elucidated, it likely relates to end-organ damage from blood pressure (BP) fluctuations and associated tissue hypoxia and vascular shear stress. Superimposed on a stiff underlying vasculature common among patients with kidney disease, and amplified by osmolar and fluid shifts inherent to the hemodialysis procedure, BPV may be particularly hazardous to hemodialysis patients. This review will provide an overview of BPV analytical issues, report recent advances in the field, and consider future directions for research and clinical application.
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