Orthostatic hypotension at the introductory phase of haemodialysis predicts all-cause mortality

Background. Since the predictive value of orthostatic hypotension (OH) at the introductory phase of haemodialysis (HD) is unknown, we examined the association between OH and all-cause death in patients who started HID between 1987 and 2001. Methods. More than three consecutive blood pressure measurements before HD treatments (pre-HID BP) were made on each of 304 patients who had recently been started on HD and were In a stable condition. OH was defined as a drop in systolic BP of >20mmHg or in diastolic BP of >10mmHg after standing. Results. Of 304 patients, 42% had OH. OH was significantly associated with pre-HD supine systolic 13 : its severity was significantly associated with a past history of cerebrovascular disease and pre-HID supine systolic BP. During a mean follow-up Of 4.0+/-3.0 years (range 0.1-13.2 years), 136 deaths were recorded. A multivariate Cox proportional hazards model analysis demonstrated that OH and a past history of cerebrovascular disease were independent predictors of all-cause death. The comparison by Kaplan-Meier analysis of the overall survival of patients with and without OH was significant. Conclusions. Our findings validate OH at the introductory phase of HD as a novel independent predictor of all-cause mortality among HD patients.