1. － Higher SBP visit-to-visit variability (SBV) has been associated
■ Background
－ Higher SBP visit-to-visit variability (SBV) has been associated
　　　with increased risk of mortality.
－ Little is known about the association of pre-end-stage renal
disease (ESRD) SBV with outcomes after dialysis initiation.
■ Aim
－ Investigate the association of pre-ESRD SBV with post-ESRD
all-cause, cardiovascular, and infection-related mortality.

2. Materials and Methods ■ Study design
　 － Retrospective cohort study from TC-CKD cohort (n = 52,172)
■ Analytic sample
　 － 17,729 US veterans who transitioned to dialysis from October
2007 through September 2011
■ Inclusion criteria
　 － with at least 3 outpatient BP measurements during one year prior to
dialysis initiation (i.e., one-year “prelude period”)
■ Exposure variable
　 － SBV defined as the SD of the intra-individual outpatient SBP values
in each patient measured during the one-year prelude period, and
categorized into quartiles (<11.6, 11.6-<15.7, 15.7-<20.4, ≥20.4 mmHg)

3. Materials and Methods (cont.)
■ Outcomes
－ Factors associated with higher prelude SBV
－ All-cause, cardiovascular, and infection-related mortality after
dialysis initiation
■ Statistical Analysis
　 － Multivariable linear regression
　 － Cox models (for all-cause) and competing risk regressions (for
cause-specific mortality) with adjustment for potential confounders;
Model 1: crude
Model 2: demographics
Model 3: model 2 + comorbidities, SBP, BMI, eGFR
Model 4: model 3 + medications, CV drug adherence, access type

4. Factors associated with prelude SBV
Characteristics
Coefficient*
95% CI
Age (per 1 year)
-0.03
-0.04 to -0.02
Marital status (married vs. non-married)
-0.44
-0.64 to -0.25
Systolic BP (per 1 mmHg)
0.15
0.14 to 0.16
Body mass index (per 1 kg/m2)
-0.10
-0.11 to -0.08
Comorbidities (yes vs. no)
Diabetes mellitus
0.64
0.38 to 0.90
Cardiovascular disease
0.44
0.23 to 0.66
Peripheral vascular disease
0.39
0.18 to 0.60
Medications (yes vs. no)
ACEIs/ARBs
0.65
0.44 to 0.85
β-blockers
0.88
0.64 to 1.13
Vasodilators
0.96
0.56 to 1.36
Erythropoiesis-stimulating agents
0.74
0.53 to 0.95
CV medication adherence (>80% vs. ≤80%)
-0.80
-1.02 to -0.57
Vascular access type (catheter vs. others)
0.34
0.13 to 0.56
Laboratory parameters
Serum albumin (per 1 g/dL)
-0.82
-1.00 to -0.65
Variables in red indicate modifiable factors.
*Coefficient for multivariable linear regression models.

7. infection-related death risk, associated with high pre-ESRD SBV.
■　Clinical implications
　－ Physicians need to be aware of the post-ESRD death risk, particularly
infection-related death risk, associated with high pre-ESRD SBV.
　－ SBV could become a treatment target through interventions aimed at
modifiable clinical factors.
■　Conclusions
　－ Greater pre-ESRD SBV, a potentially modifiable risk factor, was
independently associated with higher all-cause and infection-related
mortality after dialysis initiation.
　－ Further studies are needed to test whether modification of pre-ESRD
SBV can improve clinical outcomes among incident ESRD patients.