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Seasonal variation in predialysis systolic blood pressure and cardiovascular events in patients on maintenance hemodialysis

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Abstract

Predialysis systolic blood pressure (SBP) in patients on hemodialysis (HD) consistently followed a seasonal pattern, reaching a peak in winter and nadir in summer, similar to blood pressure in the general population. However, the relationship between seasonal variations in predialysis SBP and clinical outcomes is still under-investigated in Japanese patients on HD. This retrospective cohort study included 307 Japanese patients undergoing HD for >1 year in three dialysis clinics and evaluated the association between the standard deviation (SD) of predialysis SBP and clinical outcomes, including major adverse cardiovascular events (MACEs; cardiovascular death, nonfatal myocardial infarction or unstable angina, stroke, heart failure, and other severe cardiovascular events requiring hospitalization) with 2.5 years follow-up. The SD of predialysis SBP was 8.2 (6.4–10.9) mmHg. In the model fully adjusted for the SD of predialysis SBP, predialysis SBP, age, sex, HD vintage, Charlson comorbidity index, ultrafiltration rate, renin–angiotensin system inhibitors, corrected calcium, phosphorus, human atrial natriuretic peptide, C-reactive protein, albumin, hemoglobin, body mass index, normalized protein catabolism rate, and intradialytic SBP decline, Cox regression analyses showed that a higher SD of predialysis SBP (per 10 mmHg) was significantly associated with increased MACE risk (hazard ratio [HR], 1.89; 95% confidence interval [95% CI], 1.07–3.36) and all-cause hospitalization (HR, 1.57; 95% CI, 1.07–2.30). Therefore, greater seasonal variations in predialysis SBP were associated with worse clinical outcomes, including MACEs and all-cause hospitalization. Whether interventions to reduce seasonal variations in predialysis SBP will improve the prognosis of Japanese patients on HD must be investigated further.

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Acknowledgements

The authors thank all the participants of this research project.

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Author notes

  1. These authors contributed equally: Rina Takahashi, Tomomi Maruki

Authors and Affiliations

  1. Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan

    Rina Takahashi, Tomomi Maruki, Kiyotaka Uchiyama, Takashin Nakayama, Kaori Hayashi, Takeshi Kanda & Hiroshi Itoh

  2. Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan

    Kiyotaka Uchiyama & Naoki Washida

  3. Shibagaki Dialysis Clinic Jiyugaoka, Tokyo, Japan

    Keigo Shibagaki

  4. Department of Nephrology, Tokyo Shinagawa Hospital, Tokyo, Japan

    Akane Yanai

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  1. Rina Takahashi
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Correspondence to Kiyotaka Uchiyama.

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This study and all its protocols were reviewed and approved by the ethics committee of our hospital (approval no. 20221160), and informed consent was obtained from all patients prior to their participation.

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Takahashi, R., Maruki, T., Uchiyama, K. et al. Seasonal variation in predialysis systolic blood pressure and cardiovascular events in patients on maintenance hemodialysis. Hypertens Res 46, 2192–2202 (2023). https://doi.org/10.1038/s41440-023-01364-1

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