Among patients undergoing haemodialysis potential causes of high BP variability such as baroreceptor dysfunction, aortic stiffness and variations in intravascular volume, as well as plausible outcomes such as cerebral small-vessel disease, cerebral haemorrhage and cardiac sudden death are increased compared to the general population. Therefore increased BP variability could provide a strong potential explanation for the increased cardiovascular morbidity and mortality among patients undergoing haemodialysis. The optimum method for evaluating BP variability for patients with ESRD is unclear. Previous studies have suggested that Procyanidin-B2 visit-to-visit pre-dialysis BP variability is associated with mortality among haemodialysis patients. However, these studies are limited by lack of power and short duration of follow-up, inclusion of prevalent haemodialysis patients and use of measures of blood pressure variability that are associated with average blood pressure levels. Therefore, we planned to investigate whether visit-to-visit pre-dialysis blood pressure variability was associated with mortality among a cohort of patients commencing incident haemodialysis, independently of confounders including average blood pressure. Our study shows that intraindividual visit-to-visit variability of systolic BP is associated with all-cause mortality in incident haemodialysis patients, independently of confounders such as age, cardiovascular disease and diabetes. This is seen across measures of BP variability including VIM, which importantly is not correlated with systolic BP. The association between mortality and intraindividual visit-to-visit BP variability is not explained by the type of dialysis access, the use of antihypertensives, absolute fluid intake or variability in fluid intake. This study has a number of strengths. Duration of haemodialysis is associated with aortic stiffening and autonomic neuropathy, and thus previous renal replacement therapy may be associated with increased BP variability in prevalent cohorts. Therefore, demonstrating these results in a cohort of only incident haemodialysis patients provides greater evidence that this association may be important. We measured intraindividual visitto-visit BP variability only after 90 days of dialysis, avoiding the early period which may be complicated by acute illness, changes in medications and unstable fluid balance. We only included measurement of pre-dialysis systolic BP taken after the two-day gap to minimize the potential confounding effect of poor compliance with fluid restriction. In addition, we included readings of BP over a prolonged period with very complete data and analyzed the results using three different measures of BP variability. Reverse causality was minimized by excluding patients who had cardiovascular events during measurement of BP variability. This cohort is reasonably large with over two years of follow-up on average and includes all eligible patients in standard clinical care. However, there are also important limitations. We were not able to Anemarsaponin-BIII adjust for a number of potential cardiovascular risk factors such as smoking, body mass index and cholesterol, as these data were not available. However, among patients with ESRD, the relationship between classic risk factors and risk of adverse events is often weak or reversed and these data may not have affected our findings. We retrospectively analysed routine clinical measurements of blood pressure where technique was as per routine unit practice and not standardized as part of a clinical study protocol. However, it is not clear that use of clinical blood pressure measurements would have led to systematic misclassification of blood pressure variability.