Publication: Changes in pulse pressure during hemodialysis treatment and survival in maintenance dialysis patients
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0
Issued Date
2015
Resource Type
File Type
application/pdf
ISSN
15559041
Other identifier(s)
2-s2.0-84936874396
Rights Holder(s)
Scopus
Bibliographic Citation
Clinical Journal of the American Society of Nephrology. Vol 10, No.7 (2015), p.1179-1191
Suggested Citation
Lertdumrongluk P., Streja E., Rhee C.M., Sim J.J., Gillen D., Kovesdy C.P., Kalantar-Zadeh K. Changes in pulse pressure during hemodialysis treatment and survival in maintenance dialysis patients. Clinical Journal of the American Society of Nephrology. Vol 10, No.7 (2015), p.1179-1191. doi:10.2215/CJN.09000914 Retrieved from: https://hdl.handle.net/20.500.14740/6126
Abstract
Background and objectives Pulse pressure has been shown as a risk factor for mortality in patients on maintenance hemodialysis (MHD). However, the effect of change in pulse pressure during hemodialysis on survival in a large cohort of patients on MHD has not been sufficiently investigated. Design, setting, participants, &measurements This study examined the association between time-varying D pulse pressure (postdialysis minus predialysis pulse pressure) and mortality in a cohort of 98,577 patients on MHD (July 2001–June 2006) using Cox proportional hazard models with restricted cubic splines. Results The average patient age was 62 years old; among the patients, 33% were black and 59% had diabetes. During 134,814 patient-years of at-risk time, 16,054 (16%) patients died, with 6827 (43%) of the deaths caused by cardiovascular causes. In the models including adjustment for either predialysis systolic BP or mean arterial BP, therewas aU-shaped association between change in pulse pressure during hemodialysis and all-cause mortality. In the systolic BP plus case mix plus malnutrition-inflammation complex syndrome–adjusted model, large declines in pulse pressure (.–25 mmHg) and increases in pulse pressure.5mmHg were associated with higher all-cause mortality (reference:≥–5 to <5 mmHg): hazard ratios (95% confidence intervals [95% CIs]) for change pulse pressures of <–25,≥–25 to <–15,≥–15 to <–5, 5 to <15, 15 to <25, and ≥ 25mmHgwere 1.21 (95% CI, 1.14 to 1.29), 1.03 (95% CI, 0.97 to 1.10), 1.01 (95%CI, 0.96 to 1.06), 1.06 (95% CI, 1.01 to 1.11), 1.17 (95%CI, 1.11 to 1.24), and 1.15 (95% CI, 1.08 to 1.23), respectively. The U-shaped association was observed with cardiovascular death. Conclusions Modest reductions in pulse pressure after hemodialysis are associated with the greatest survival, whereas large declines or rises in pulse pressure are related to higher mortality. Trials determining howto modify pulse pressure response to improve survival in the hemodialysis population are indicated. © 2015 by the American Society of Nephrology.
Subject(s)
Albumin
Bicarbonate
Calcium
Creatinine
Ferritin
Hemoglobin
Nitrogen
Phosphorus
Adult
Article
Blood cell count
Blood pressure variability
Cardiovascular mortality
Cardiovascular risk
Dialysis
Diastolic blood pressure
Female
Follow up
Hemodialysis
Human
Iron binding capacity
Major clinical study
Male
Mean arterial pressure
Mortality
Outcome assessment
Sensitivity analysis
Systolic blood pressure
Adverse effects
Aged
Arterial stiffness
Blood pressure
Cardiovascular Diseases
Cause of death
Cohort analysis
Complication
Epidemiology
Factual database
Kidney Diseases
Middle aged
Mortality
Multivariate analysis
Pathophysiology
Proportional hazards model
Risk assessment
Risk factor
Time factor
Treatment outcome
United States
Aged
Blood Pressure
Cardiovascular Diseases
Cause of Death
Cohort Studies
Databases, Factual
Female
Humans
Kidney Diseases
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Renal Dialysis
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Vascular Stiffness
Bicarbonate
Calcium
Creatinine
Ferritin
Hemoglobin
Nitrogen
Phosphorus
Adult
Article
Blood cell count
Blood pressure variability
Cardiovascular mortality
Cardiovascular risk
Dialysis
Diastolic blood pressure
Female
Follow up
Hemodialysis
Human
Iron binding capacity
Major clinical study
Male
Mean arterial pressure
Mortality
Outcome assessment
Sensitivity analysis
Systolic blood pressure
Adverse effects
Aged
Arterial stiffness
Blood pressure
Cardiovascular Diseases
Cause of death
Cohort analysis
Complication
Epidemiology
Factual database
Kidney Diseases
Middle aged
Mortality
Multivariate analysis
Pathophysiology
Proportional hazards model
Risk assessment
Risk factor
Time factor
Treatment outcome
United States
Aged
Blood Pressure
Cardiovascular Diseases
Cause of Death
Cohort Studies
Databases, Factual
Female
Humans
Kidney Diseases
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Renal Dialysis
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Vascular Stiffness