American Journal of Kidney Diseases
Volume 53, Issue 1 , Pages 70-78, January 2009

Blood Pressure and Mortality Risk on Peritoneal Dialysis

  • Udaya P. Udayaraj, MD

      Affiliations

    • UK Renal Registry, Southmead Hospital, Bristol, UK
    • Corresponding Author InformationAddress correspondence to Udaya P. Udayaraj, MD, UK Renal Registry, Southmead Hospital, Southmead Rd, Bristol, BS10 5NB UK
  • ,
  • Retha Steenkamp, MSc

      Affiliations

    • UK Renal Registry, Southmead Hospital, Bristol, UK
  • ,
  • Fergus J. Caskey, MD

      Affiliations

    • UK Renal Registry, Southmead Hospital, Bristol, UK
    • Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
  • ,
  • Chris Rogers, PhD

      Affiliations

    • Bristol Heart Institute, University of Bristol, Bristol, UK
  • ,
  • Dorothea Nitsch, MD, MSc

      Affiliations

    • Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  • ,
  • David Ansell, MBBS

      Affiliations

    • UK Renal Registry, Southmead Hospital, Bristol, UK
  • ,
  • Charles R.V. Tomson, DM

      Affiliations

    • UK Renal Registry, Southmead Hospital, Bristol, UK
    • Richard Bright Renal Unit, Southmead Hospital, Bristol, UK

Received 23 August 2007; accepted 26 August 2008. published online 25 November 2008.

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.

Index Words: Blood pressure, mortality, peritoneal dialysis, transplant waiting list, diabetes

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 Originally published online as doi:10.1053/j.ajkd.2008.08.030 on November 25, 2008.

PII: S0272-6386(08)01422-4

doi:10.1053/j.ajkd.2008.08.030

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)

American Journal of Kidney Diseases
Volume 53, Issue 1 , Pages 70-78, January 2009