1. Association of all-cause mortality with pre-dialysis systolic blood pressure and its peridialytic change in chronic hemodialysis patients.
- Author
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Zhang H, Preciado P, Wang Y, Meyring-Wosten A, Raimann JG, Kooman JP, van der Sande FM, Usvyat LA, Maddux D, Maddux FW, and Kotanko P
- Subjects
- Adult, Aged, Female, Humans, Kidney Failure, Chronic therapy, Male, Prognosis, Renal Dialysis adverse effects, Survival Rate, Blood Pressure, Hypertension physiopathology, Kidney Failure, Chronic mortality, Mortality trends, Renal Dialysis mortality, Weight Gain
- Abstract
Background: Pre-dialysis systolic blood pressure (pre-HD SBP) and peridialytic SBP change have been associated with morbidity and mortality among hemodialysis (HD) patients in previous studies, but the nature of their interaction is not well understood., Methods: We analyzed pre-HD SBP and peridialytic SBP change (calculated as post-HD SBP minus pre-HD SBP) between January 2001 and December 2012 in HD patients treated in US Fresenius Medical Care facilities. The baseline period was defined as Months 4-6 after HD initiation, and all-cause mortality was noted during follow-up. Only patients who survived baseline and had no missing covariates were included. Censoring events were renal transplantation, modality change or study end. We fitted a Cox proportional hazard model with a bivariate spline functions for the primary predictors (pre-HD SBP and peridialytic SBP change) with adjustment for age, gender, race, diabetes, access-type, relative interdialytic weight gain, body mass index, albumin, equilibrated normalized protein catabolic rate and ultrafiltration rate., Results: A total of 172 199 patients were included. Mean age was 62.1 years, 61.6% were white and 55% were male. During a median follow-up of 25.0 months, 73 529 patients (42.7%) died. We found that a peridialytic SBP rise combined with high pre-HD SBP was associated with higher mortality. In contrast, when concurrent with low pre-HD SBP, a peridialytic SBP rise was associated with better survival., Conclusion: The association of pre-HD and peridialytic SBP change with mortality is complex. Our findings call for a joint, not isolated, interpretation of pre-HD SBP and peridialytic SBP change., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.)
- Published
- 2020
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