Abstract: Objective To evaluate the prognostic value of average real variability (ARV) of interdialytic blood pressure for cardiovascular mortality in patients on maintenance hemodialysis (MHD). Methods A total of 103 MHD patients were enrolled and 44-hour ambulatory blood pressure monitoring was carried out
after the second hemodialysis session in a week. Standard deviation (SD), coefficient of variation (CV), and ARV of the interdialytic ambulatory systolic blood pressure in the 44-hour period (44h-SBP) was calculated. Patients were followed up for two years and the relevant indexes were analyzed. Results Kaplan- Meier analysis demonstrated that the survival curves were not significantly different between groups divided by means of the averaged SD (P=0.647) or CV (P=0.098) of 44h-SBP. However, the survival rate was significantly lower in the group with higher ARV of 44h- SBP than in that with lower ARV of 44h- SBP (77.8% vs.98.0%, P=0.002). Multivariate Cox regression demonstrated that ARV of 44h-SBP (HR=1.132, P=0.017) and hs-CRP (HR=1.179, P=0.009) were the independent risk factors for cardiovascular death. Conclusions The ARV of 44h-SBP had a higher prognostic value for cardiovascular death, superior to the averaged SD or CV of 44h-SBP.

Key words: Maintenance hemodialysis, Hypertension, Average real variability (ARV), Cardiovascular death