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Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study

Hypertension Research volume 48, pages 2045–2057 (2025)Cite this article

A Comment to this article was published on 01 September 2025

Abstract

The prognostic utility of the combined assessment of pre-hemodialysis systolic blood pressure (SBP) and pulse rate compared to their independent assessment is unclear. In this nationwide cohort study, we aimed to determine whether their combined assessment could enhance the prognostic utility in patients on maintenance hemodialysis using the Japanese Renal Data Registry database. Exposure was defined as a combination of SBP and pulse rate. Forty-eight levels of exposure groups were created: SBP (<100, 100– < 120, 120– < 140, 140– < 160 [reference], 160– < 180, and ≥180 mmHg) and pulse rate (<50, 50– < 60, 60– < 70 [reference], 70– < 80, 80– < 90, 90– < 100, 100– < 110, and ≥110 beats/min). The primary and secondary outcomes were 1-year all-cause and cardiovascular mortalities, respectively. Multivariate Cox proportional hazards models were used, and multiplicative and additive interactions were assessed. The combined model for mortality and cardiac mortality was statistically better than the separate SBP and pulse rate model. Lower SBP was associated with higher risk of all-cause mortality irrespective of pulse rate. Most categories of lower SBP or higher pulse rate vs. the 120– < 140 mmHg and 70– < 80 beats/min category had positive relative excess risk due to interactions, with similar findings observed for cardiac mortality. Combined assessment of pre-dialysis SBP and pulse rate may help the simple stratification of patients with excess risks that cannot be identified by separate SBP and pulse rate assessment.

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Data availability

Data will be available immediately after publication with no end dates. Data will be shared upon reasonable request to the corresponding author with permission from the JRDR investigators. Restrictions apply to the availability of the data analyzed in this study to preserve patient confidentiality.

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Acknowledgements

We wish to acknowledge the efforts of the members of the Subcommittee for JRDR Regional Cooperation and staff members of the dialysis facilities who participated in the survey and responded to the questionnaires. This study utilized data from the JRDR. The interpretation and reporting of these data are solely the responsibility of the authors and do not reflect the official views or policies of the JSDT.

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Author notes

  1. These authors contributed equally: Nobuhiko Joki, Tatsunori Toida, Kakuya Niihata

Authors and Affiliations

  1. Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan

    Nobuhiko Joki, Tatsunori Toida & Kenji Nakata

  2. The Committee of Renal Data Registry, the Japanese Society for Dialysis Therapy, Tokyo, Japan

    Nobuhiko Joki, Masanori Abe & Norio Hanafusa

  3. School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Miyazaki, Japan

    Tatsunori Toida

  4. Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan

    Tatsunori Toida, Kakuya Niihata, Ryohei Inanaga & Noriaki Kurita

  5. Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan

    Ryohei Inanaga

  6. Divisions of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan

    Masanori Abe

  7. Department of Blood Purification, Tokyo Women’s Medical University, Tokyo, Japan

    Norio Hanafusa

  8. Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan

    Noriaki Kurita

  9. The Subcommittee of Statistical Analysis, The Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan

    Noriaki Kurita

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Contributions

Research idea and study design: NJ, NK; data acquisition: NJ, MA, NH; data analysis/interpretation: NJ, TT, K. Niihata, RI, K. Nakata; statistical analysis: TT, K. Niihata, NK; supervision or mentorship: MA, NH. Each author contributed important intellectual content during manuscript drafting or revision, agreed to be personally accountable for the individual’s own contributions, and ensured that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, were appropriately investigated and resolved, including documentation in the literature, if appropriate.

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Correspondence to Noriaki Kurita.

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Conflict of interest

TT received consulting fees from Astellas Pharma Inc., as well as payments and educational events from Torii Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., AstraZeneca K.K., and Nobelpharma Co., Ltd. RI received payment for speaking from Astellas Pharma, Inc., Novartis Pharma K.K., and Otsuka Pharmaceutical. MA received payment for speaking from Novartis Pharma K.K. and Otsuka Pharmaceutical. NK received consulting fees from GlaxoSmithKline K.K. and payments for speaking and educational events from Eisai Co., Ltd., Taisho Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., GlaxoSmithKline K.K., Takeda Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., and Baxter Corporation.

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Joki, N., Toida, T., Niihata, K. et al. Combined pre-dialysis systolic blood pressure and pulse rate assessment for 1-year all-cause and cardiovascular mortality in patients on hemodialysis: a nationwide cohort study. Hypertens Res 48, 2045–2057 (2025). https://doi.org/10.1038/s41440-025-02231-x

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