Poor blood pressure, glucose control linked to higher mortality in hemodialysis patients

Failure to manage blood pressure and blood glucose levels in hemodialysis patients is associated with higher mortality rates, according to a study.

The National Evidence-based healthcare Collaborating Agency (NECA)’s Patient-Oriented Medical Technology Optimization Research Corps released on Monday the results of a clinical value assessment on “Blood Pressure and Blood Sugar Management to Improve Mortality in Hemodialysis Patients.”

As the number of older adults and people with chronic diseases increases, patients requiring hemodialysis also grew, with more than 15,000 new patients receiving hemodialysis every year.

Despite advances in dialysis treatment technology, mortality rates for hemodialysis patients have not declined significantly in recent years, and the importance of blood pressure and blood glucose management has been emphasized to improve mortality rates, especially from cardiovascular disease, the leading cause of death among dialysis patients.

According to the results of the study, "Developing Blood Pressure and Glucose Treatment Guidelines to Improve Mortality and Quality of Life in Dialysis Patients and Optimize Costs," poor blood pressure and glucose control in hemodialysis patients increase their risk of death.

The risk of death increased with increasing systolic blood pressure, with systolic blood pressure of 180 mm Hg or higher being 1.2 times more likely than those with normal blood pressure.

The risk of death from cardiovascular disease was also 1.12 times higher for systolic blood pressure between 160 mm Hg and 180 mm Hg and 1.29 times higher for systolic blood pressure above 180 mm Hg than for patients with normal blood pressure.

The risk of death was also 1.26 times higher for those with a glycated hemoglobin of 8.5 to 9.5 percent and 1.56 times higher for those with a glycated hemoglobin of 9.5 percent or more, compared to those with a glycated hemoglobin of 6.5 to 7.5 percent, an important indicator of blood sugar management.

The risk of death from cardiovascular disease was also 1.46 times higher for patients with a glycated hemoglobin of 8.5 to 9.5 percent and 1.47 times higher for those with a glycated hemoglobin of 9.5 percent or higher than those with a glycated hemoglobin of 6.5 to 7.5 percent.

The project group also looked at the blood pressure and blood sugar status of hemodialysis patients in Korea and found that many patients had poorly controlled blood pressure and blood sugar.

Of the 70,780 hemodialysis patients in Korea from 2001 to 2020, 63.9 percent had a systolic blood pressure of 140 mm Hg or higher, and 21.7 percent had a systolic blood pressure of 160 mm Hg or higher, a blood pressure range that increases the risk of death.

In addition, of the 24,245 hemodialysis patients with diabetes, 49.0 percent had a glycated hemoglobin of 6.5 percent or higher, and 25.6 percent had a glycated hemoglobin of 7.5 percent or higher, which increases the risk of death.

Based on these findings, the project team's clinical value assessment confirmed that good blood pressure and sugar control in hemodialysis patients is critical to reducing mortality.

Participating experts also emphasized the importance of medical staff's attention and patients' efforts to ensure proper blood pressure and sugar control in clinical practice.

"We hope that our findings will increase attention to the importance of blood pressure and blood glucose management in hemodialysis patients, which will help improve mortality rates among hemodialysis patients," said Hur Dae-seok, the project team’s leader.