Abstract
Blood pressure (BP) is a known prognostic marker for mortality in patients on maintenance hemodialysis (MHD). However, definition of the BP and its optimal values vary essentially among different MHD populations. Our purpose was to clarify these important clinical parameters in a Chinese MHD cohort. Accordingly, we reviewed the available records of patients on regular MHD during the past 10 years and made a comparison between the deceased (n=81) and survival ones (n=131). Multiple logistic regression and Kaplan–Meier survival analysis were used to examine the effect of BP on mortality and long-term survival, respectively. The all-cause mortality in our patients was 38.2%, in which 49.4% was from cardio-cerebrovascular deaths. Using the multiple logistic regression, we found that the sitting (the same definition hereafter) pre-dialysis systolic BP (SBP) was significantly associated with both the all-cause mortality and cardio-cerebrovascular deaths exclusively in patients of 60–80 years. Moreover, a pre-dialysis SBP of 140–160 mmHg in these patients had the minimum all-cause mortality (23.5%) against that conferred by either a lower (42.1%) or higher SBP value (61.5%). This observation was further confirmed by the Kaplan–Meier survival analysis. As fresh gain to the practice of hemodialysis, our report revealed that BP worked in a time-dependent way among a Chinese MHD cohort and highlighted a U-shaped association between the pre-dialysis SBP and all-cause mortality. These findings may hence help to obtain optimal BP control for better survival and lend some prognostic insight into mortality in these MHD patients.
Highlights
The incidence of cardiovascular events has increased significantly with the deterioration of renal function in such a way that it surged from 2.1% annually to 36.6%, when estimated glomerular filtration rate decreased from more than 60 to less than 15 ml/min/1.73 m2 [1]
Between the deceased and surviving patients, there were no differences with regard to the gender composition, age, time of dialysis, body mass index, Hb concentration, lipid profiles, albumin, electrolytes and hemodialysis-associated factors including the Kt/V, Intact parathyroid hormone (iPTH) and transferrin saturation (TSAT) (Table 1)
The ensuing multiple logistic regression did not support the pre-dialysis systolic BP (SBP) as a significant determinant, prompting us to consider the existence of interfering factor
Summary
The incidence of cardiovascular events has increased significantly with the deterioration of renal function in such a way that it surged from 2.1% annually to 36.6%, when estimated glomerular filtration rate decreased from more than 60 to less than 15 ml/min/1.73 m2 [1]. Cardio-cerebrovascular diseases (CVDs) accounted for 52.8% of all-cause mortality in MHD patients, followed by infectious diseases (21.6%) and malignancies (16.0%) [3]. Hypertension has long been recognized as one of the traditional CVD risk factors in these patients [4] and blood pressure (BP) is believed to be a prognostic marker for mortality [5]. It was known that category (ambulatory, pre- or post-dialysis), measuring methods (supine, sitting or standing) and optimal values of the BP varied essentially among different MHD populations [6]. In this regard, mortality predictor was intradialysis hypotension as orthostatic systolic BP (SBP) of 110–119
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