Nadir Systolic Blood Pressure during Hemodialysis Highly Correlates with Hospital Admission

Background: Establishing blood pressure (BP) targets during hemodialysis (HD) may improve the ability to achieve dry weight and avoid hospitalization. While Kt/V targets have been mandated and maximum fluid removal recommended, BP targets for HD have not been established. The purpose of this study was to identify whether the lowest systolic BP values attained during HD (LSBP) were associated with hospitalization. Hypothesis: LSBP < 100 or >160 mm Hg is associated with an increased risk of hospitalization Methods: We performed a retrospective cohort study of 1668 HD patients cared for by nephrologists at Wake Forest School of Medicine from 1/1/2018 to 12/31/2023 and admitted to Atrium Health Wake Forest Baptist Medical Center for deteriorations in health. We performed a mixed model logistic regression where individual was the random effect, with the outcome variable being HD sessions occurring 0-3 days prior to a hospital admission vs. HD sessions unrelated to hospital admission and dependent variables including age, race, gender, LSBP, dialysis dose. Results: There were 497,561 HD treatments during this time period and 1984 hospital admissions in 1668 HD patients (58% male, 54% White, 45% Black). During the study period there were 1984 admissions for patients who had undergone HD 0-3 days prior to admission. The figure shows the odds ratio for LBSP for HD treatments 0-3 days pre-admission vs. HD treatments not associated with admission, with a LSBP 120 to <130 mm HG as the reference range. LSBP readings from 100-150 mm Hg were associated with the lowest risk of hospitalization. Conclusion: A nadir HD systolic BP <100 or >150 mm Hg is associated with an increased risk of hospital admissions. Targeting nadir systolic BP during HD may help to prevent morbidity and possibly mortality.