Blood Pressure and Mortality Risk on Peritoneal Dialysis
Received 23 August 2007; accepted 26 August 2008. published online 25 November 2008.
Refers to article:
Blood Pressure and Mortality Risk in Patients Treated by Peritoneal Dialysis
Philip G. Zager, Mark R. Rohrscheib
American Journal of Kidney Diseases
January 2009 (Vol. 53, Issue 1, Pages 9-11) Full Text |
Full-Text PDF (114 KB)
Background
The association of baseline blood pressure (BP) and mortality in incident peritoneal dialysis patients has not been adequately studied.
Study Design
Cohort study.
Setting & Participants
2,770 patients on PD therapy at 180 days from start of renal replacement therapy in England and Wales between 1997 and 2004.
Predictors
Systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) measured in the first 6 months of renal replacement therapy and other baseline demographic and laboratory variables.
Outcomes
All-cause mortality was studied using time-stratified Cox regression models (to account for nonproportionality) dividing follow-up time into 4 intervals: year 1 (days 180 to 365), years 2 to 3, years 4 to 5, and years 6+. Interactions between BP components and transplant waitlist and diabetes status were explored.
Results
Median follow-up was 3.7 years (range, 0.1 to 9.9 years), and 1,104 deaths were observed. In fully adjusted analyses, greater SBP, DBP, MAP, and PP were associated with decreased mortality in the first year, but greater SBP and PP were associated with increased late mortality (in years 6+). However, in the subgroup of patients placed on the transplant waitlist within 6 months of starting renal replacement therapy, greater SBP, DBP, MAP, and PP were not associated with decreased mortality in the first year.
Limitations
Exclusion of 3,086 patients because of missing BP data. No data were available for cardiac function or antihypertensive medication.
Conclusions
Although greater SBP, DBP, MAP, and PP appear protective against early mortality in the overall cohort, this effect is not seen in patients registered on the national transplant waiting list within 6 months of starting renal replacement therapy.
ABSTRACT