Association between Blood Pressure Variability and Prognosis in Diabetic Patients on Maintenance Haemodialysis

Background: Patients receiving dialysis who also have diabetes mellitus have high mortality. This study aimed to explore blood pressure variability (BPV) in diabetic patients treated with hemodialysis and analysis of prognosis. Methods: This study retrospectively colected pre-dialysis and intra-dialysis blood pressure (BP) of maintenance hemodialysis (MHD) patients in the haemodialysis centre of Guangdong Provincial People's Hospital in March 2020. The patients were divided into diabetic and non-diabetic groups, and the differences in mean pre-dialysis and dialysis BP and BPV were compared between the two groups. They were also grouped according to whether they had diabetic kidney disease (DKD), whether they were taking antihypertensive drugs, and the absolute value of BP for subgroup analysis.BPV was expressed as the standard deviation (SD) and coeffi cient of variatioil (CV) of multiple BP readings and the average real variability (ARV). Survival analysis was performed using the multivariate Cox proportional hazard model, and Kaplan-Meyer survival analyses with log-rank tests were performed to show differences between groups. Results: A total of 208 patients were included, of whom 81 had diabetes mellitus.Compared with the non-diabetic group, the diabetic group showed a non-significant difference in absolute BP levels, and greater SBP variability in both pre-dialysis and intra-dialysis. According to the Kaplan-Meier estimator, high SBP SD and CV in dialysis were associated with high all-cause mortality (log-rank 7.12, p = 0.008). Cox multivariate analysis also showed a significant association between diabetes combined with high SBP variability and all-cause mortality (HR 2.259; 95% CI 1.017 -5.018). Conclusion: Compared with nondiabetic patients, SBP variability is higher in diabetic patients with MHD, both pre-dialysis and intra-dialysis.Diabetes mellitus combined with high dialysis BPV is independently associated with increased all-cause mortality.