Supplementary Material for: Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Background: The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population. Methods: Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included. Results: A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07–1.19; p p p = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06–1.22; p p = 0.01) and cardiovascular (p = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01–1.17; p = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52–1.42; p = 0.56). Conclusions: This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).背景：血液透析患者的血压变异性（blood pressure variability, BPV）预后价值尚无定论。本研究旨在探讨血液透析人群中血压变异性与临床结局的关联。方法：检索PubMed/Medline、EMBASE、Ovid、Cochrane图书馆及Web of Science数据库中截至2020年4月1日发表的相关文献，纳入探讨血液透析患者血压变异性与预后关联的研究。结果：本分析共纳入14项研究，涉及37976例患者。在血液透析患者中，收缩压变异性与全因死亡（风险比[HR]：1.13；95%置信区间[CI]：1.07~1.19；P<0.001）及心血管死亡（HR：1.14；95%CI：1.06~1.22；P=0.01）风险升高显著相关。尽管血液透析患者的舒张压变异性与全因死亡相关（HR：1.09；95%CI：1.01~1.17；P=0.02），但无法预测心血管死亡（HR：0.86；95%CI：0.52~1.42；P=0.56）。结论：本荟萃分析显示，血液透析患者的透析间期收缩压变异性与全因死亡及心血管死亡风险升高均显著相关。此外，收缩压变异系数被证实是预测全因死亡与心血管死亡的颇具潜力的血压变异性评估指标。而44小时动态收缩压变异性、透析中收缩压变异性及舒张压变异性相关指标用于血液透析人群预后评估的价值，尚需进一步研究验证（PROSPERO注册编号：CRD42019139215）。