Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality
Background Mortality is extremely high immediately after the transition to dialysis therapy, but the association of blood pressure (BP) before dialysis therapy initiation with mortality after dialysis therapy initiation remains unknown. Study Design Observational study. Setting & Participants 17...
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| Veröffentlicht in: | American journal of kidney diseases 2017-08, Vol.70 (2), p.207-217 |
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| creator | Sumida, Keiichi, MD Molnar, Miklos Z., MD, PhD Potukuchi, Praveen K., MS Thomas, Fridtjof, PhD Lu, Jun Ling, MD Ravel, Vanessa A., MPH Soohoo, Melissa, MPH Rhee, Connie M., MD, MSc Streja, Elani, MPH, PhD Sim, John J., MD Yamagata, Kunihiro, MD, PhD Kalantar-Zadeh, Kamyar, MD, MPH, PhD Kovesdy, Csaba P., MD |
| description | Background Mortality is extremely high immediately after the transition to dialysis therapy, but the association of blood pressure (BP) before dialysis therapy initiation with mortality after dialysis therapy initiation remains unknown. Study Design Observational study. Setting & Participants 17,729 US veterans transitioning to dialysis therapy in October 2007 to September 2011, with a median follow-up of 2.0 years. Predictor Systolic (SBP) and diastolic BP (DBP) averaged over the last 1-year predialysis transition period as 6 ( |
| doi_str_mv | 10.1053/j.ajkd.2016.12.020 |
| format | Article |
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Study Design Observational study. Setting & Participants 17,729 US veterans transitioning to dialysis therapy in October 2007 to September 2011, with a median follow-up of 2.0 years. Predictor Systolic (SBP) and diastolic BP (DBP) averaged over the last 1-year predialysis transition period as 6 (<120 to ≥160 mm Hg in 10−mm Hg increments) and 5 (<60 to ≥90 mm Hg in 10−mm Hg increments) categories, respectively, and as continuous measures. Outcomes & Measurements Postdialysis all-cause mortality, assessed over different follow-up periods (ie, <3, 3-<6, 6-<12, and ≥12 months after dialysis therapy initiation) using Cox regressions adjusted for demographics, comorbid conditions, medications, cardiovascular medication adherence, body mass index, estimated glomerular filtration rate, and type of vascular access. Results Mean predialysis SBP and DBP were 141.2 ± 16.1 (SD) and 73.7 ± 10.6 mm Hg, respectively. There was a reverse J-shaped association of SBP with all-cause mortality, with significantly higher mortality seen with SBP < 140 mm Hg. Mortality risks associated with lower SBP were greatest in the first 3 months after dialysis therapy initiation, with multivariable-adjusted HRs of 2.40 (95% CI, 1.96-2.93), 1.99 (95% CI, 1.66-2.40), 1.35 (95% CI, 1.13-1.62), 0.98 (95% CI, 0.78-1.22), and 0.76 (95% CI, 0.57-1.00) for SBP <120, 120 to <130, 130 to <140, 150 to <160, and ≥160 (vs 140-<150) mm Hg, respectively. No consistent association was observed between predialysis DBP and postdialysis mortality. Limitations Results cannot be inferred to show causality and may not be generalizable to women or the general US population. Conclusions Lower predialysis SBP is associated with higher all-cause mortality in the immediate postdialysis period. Predialysis DBP showed no consistent association with postdialysis mortality. Further studies are needed to clarify ideal predialysis SBP levels among incident dialysis patients as a potential means to improve the excessively high early dialysis mortality.]]></description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2016.12.020</identifier><identifier>PMID: 28291617</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Blood Pressure ; Blood pressure (BP) ; Blood Pressure Determination ; chronic kidney disease (CKD) ; dialysis ; dialysis initiation ; diastolic BP (DBP) ; end-stage renal disease (ESRD) ; Female ; Humans ; incident ESRD ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - therapy ; Male ; mortality ; Nephrology ; Renal Dialysis - mortality ; Retrospective Studies ; reverse epidemiology ; risk factor paradox ; systolic BP (SBP) ; Time Factors ; transition ; transition of care ; United States ; Veterans Health</subject><ispartof>American journal of kidney diseases, 2017-08, Vol.70 (2), p.207-217</ispartof><rights>2017</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c576t-f2ae798c27d097f6909dd1b32d3ad3e3987cde6e3c1ae4c8066f6be4ee8ec5863</citedby><cites>FETCH-LOGICAL-c576t-f2ae798c27d097f6909dd1b32d3ad3e3987cde6e3c1ae4c8066f6be4ee8ec5863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0272638617305061$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28291617$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sumida, Keiichi, MD</creatorcontrib><creatorcontrib>Molnar, Miklos Z., MD, PhD</creatorcontrib><creatorcontrib>Potukuchi, Praveen K., MS</creatorcontrib><creatorcontrib>Thomas, Fridtjof, PhD</creatorcontrib><creatorcontrib>Lu, Jun Ling, MD</creatorcontrib><creatorcontrib>Ravel, Vanessa A., MPH</creatorcontrib><creatorcontrib>Soohoo, Melissa, MPH</creatorcontrib><creatorcontrib>Rhee, Connie M., MD, MSc</creatorcontrib><creatorcontrib>Streja, Elani, MPH, PhD</creatorcontrib><creatorcontrib>Sim, John J., MD</creatorcontrib><creatorcontrib>Yamagata, Kunihiro, MD, PhD</creatorcontrib><creatorcontrib>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</creatorcontrib><creatorcontrib>Kovesdy, Csaba P., MD</creatorcontrib><title>Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description><![CDATA[Background Mortality is extremely high immediately after the transition to dialysis therapy, but the association of blood pressure (BP) before dialysis therapy initiation with mortality after dialysis therapy initiation remains unknown. Study Design Observational study. Setting & Participants 17,729 US veterans transitioning to dialysis therapy in October 2007 to September 2011, with a median follow-up of 2.0 years. Predictor Systolic (SBP) and diastolic BP (DBP) averaged over the last 1-year predialysis transition period as 6 (<120 to ≥160 mm Hg in 10−mm Hg increments) and 5 (<60 to ≥90 mm Hg in 10−mm Hg increments) categories, respectively, and as continuous measures. Outcomes & Measurements Postdialysis all-cause mortality, assessed over different follow-up periods (ie, <3, 3-<6, 6-<12, and ≥12 months after dialysis therapy initiation) using Cox regressions adjusted for demographics, comorbid conditions, medications, cardiovascular medication adherence, body mass index, estimated glomerular filtration rate, and type of vascular access. Results Mean predialysis SBP and DBP were 141.2 ± 16.1 (SD) and 73.7 ± 10.6 mm Hg, respectively. There was a reverse J-shaped association of SBP with all-cause mortality, with significantly higher mortality seen with SBP < 140 mm Hg. Mortality risks associated with lower SBP were greatest in the first 3 months after dialysis therapy initiation, with multivariable-adjusted HRs of 2.40 (95% CI, 1.96-2.93), 1.99 (95% CI, 1.66-2.40), 1.35 (95% CI, 1.13-1.62), 0.98 (95% CI, 0.78-1.22), and 0.76 (95% CI, 0.57-1.00) for SBP <120, 120 to <130, 130 to <140, 150 to <160, and ≥160 (vs 140-<150) mm Hg, respectively. No consistent association was observed between predialysis DBP and postdialysis mortality. Limitations Results cannot be inferred to show causality and may not be generalizable to women or the general US population. Conclusions Lower predialysis SBP is associated with higher all-cause mortality in the immediate postdialysis period. Predialysis DBP showed no consistent association with postdialysis mortality. Further studies are needed to clarify ideal predialysis SBP levels among incident dialysis patients as a potential means to improve the excessively high early dialysis mortality.]]></description><subject>Aged</subject><subject>Blood Pressure</subject><subject>Blood pressure (BP)</subject><subject>Blood Pressure Determination</subject><subject>chronic kidney disease (CKD)</subject><subject>dialysis</subject><subject>dialysis initiation</subject><subject>diastolic BP (DBP)</subject><subject>end-stage renal disease (ESRD)</subject><subject>Female</subject><subject>Humans</subject><subject>incident ESRD</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>mortality</subject><subject>Nephrology</subject><subject>Renal Dialysis - mortality</subject><subject>Retrospective Studies</subject><subject>reverse epidemiology</subject><subject>risk factor paradox</subject><subject>systolic BP (SBP)</subject><subject>Time Factors</subject><subject>transition</subject><subject>transition of care</subject><subject>United States</subject><subject>Veterans Health</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk1v1DAQtRCIbgt_gAPKkUuCPza2I6FKtBSo1ApQ4Wx57Qk49drFdirtv8fRlgp66GkO896bmfcGoVcEdwT37O3U6enadhQT3hHaYYqfoBXpKWu5ZPIpWmEqaMuZ5AfoMOcJYzwwzp-jAyrpQDgRK_TtxMdom68Jcp4TNCcwxlrOgytOFxdDE8fmUrtQIOhgoPngtN9llxsdbHM1bzL8niGU5jKmor0ruxfo2ah9hpd39Qj9-Hj2_fRze_Hl0_np-4vW9IKXdqQaxCANFRYPYuQDHqwlG0Yt05YBG6QwFjgwQzSsjcScj3wDawAJppecHaHjve7NvNmCNXWJpL26SW6r005F7dT_neB-qZ_xVvU95WKNq8CbO4EU6w25qK3LBrzXAeKcFZFCyL46TSqU7qEmxZwTjPdjCFZLFmpSSxZqyUIRqmoWlfT63wXvKX_Nr4B3ewBUm24dJJWNg2qydQlMUTa6x_WPH9CNd8EZ7a9hB3mKcwo1AEVUrgR1tXzD8gx1Mu4xJ-wP2gix3w</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Sumida, Keiichi, MD</creator><creator>Molnar, Miklos Z., MD, PhD</creator><creator>Potukuchi, Praveen K., MS</creator><creator>Thomas, Fridtjof, PhD</creator><creator>Lu, Jun Ling, MD</creator><creator>Ravel, Vanessa A., MPH</creator><creator>Soohoo, Melissa, MPH</creator><creator>Rhee, Connie M., MD, MSc</creator><creator>Streja, Elani, MPH, PhD</creator><creator>Sim, John J., MD</creator><creator>Yamagata, Kunihiro, MD, PhD</creator><creator>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</creator><creator>Kovesdy, Csaba P., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170801</creationdate><title>Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality</title><author>Sumida, Keiichi, MD ; Molnar, Miklos Z., MD, PhD ; Potukuchi, Praveen K., MS ; Thomas, Fridtjof, PhD ; Lu, Jun Ling, MD ; Ravel, Vanessa A., MPH ; Soohoo, Melissa, MPH ; Rhee, Connie M., MD, MSc ; Streja, Elani, MPH, PhD ; Sim, John J., MD ; Yamagata, Kunihiro, MD, PhD ; Kalantar-Zadeh, Kamyar, MD, MPH, PhD ; Kovesdy, Csaba P., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c576t-f2ae798c27d097f6909dd1b32d3ad3e3987cde6e3c1ae4c8066f6be4ee8ec5863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Blood Pressure</topic><topic>Blood pressure (BP)</topic><topic>Blood Pressure Determination</topic><topic>chronic kidney disease (CKD)</topic><topic>dialysis</topic><topic>dialysis initiation</topic><topic>diastolic BP (DBP)</topic><topic>end-stage renal disease (ESRD)</topic><topic>Female</topic><topic>Humans</topic><topic>incident ESRD</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>mortality</topic><topic>Nephrology</topic><topic>Renal Dialysis - mortality</topic><topic>Retrospective Studies</topic><topic>reverse epidemiology</topic><topic>risk factor paradox</topic><topic>systolic BP (SBP)</topic><topic>Time Factors</topic><topic>transition</topic><topic>transition of care</topic><topic>United States</topic><topic>Veterans Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sumida, Keiichi, MD</creatorcontrib><creatorcontrib>Molnar, Miklos Z., MD, PhD</creatorcontrib><creatorcontrib>Potukuchi, Praveen K., MS</creatorcontrib><creatorcontrib>Thomas, Fridtjof, PhD</creatorcontrib><creatorcontrib>Lu, Jun Ling, MD</creatorcontrib><creatorcontrib>Ravel, Vanessa A., MPH</creatorcontrib><creatorcontrib>Soohoo, Melissa, MPH</creatorcontrib><creatorcontrib>Rhee, Connie M., MD, MSc</creatorcontrib><creatorcontrib>Streja, Elani, MPH, PhD</creatorcontrib><creatorcontrib>Sim, John J., MD</creatorcontrib><creatorcontrib>Yamagata, Kunihiro, MD, PhD</creatorcontrib><creatorcontrib>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</creatorcontrib><creatorcontrib>Kovesdy, Csaba P., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sumida, Keiichi, MD</au><au>Molnar, Miklos Z., MD, PhD</au><au>Potukuchi, Praveen K., MS</au><au>Thomas, Fridtjof, PhD</au><au>Lu, Jun Ling, MD</au><au>Ravel, Vanessa A., MPH</au><au>Soohoo, Melissa, MPH</au><au>Rhee, Connie M., MD, MSc</au><au>Streja, Elani, MPH, PhD</au><au>Sim, John J., MD</au><au>Yamagata, Kunihiro, MD, PhD</au><au>Kalantar-Zadeh, Kamyar, MD, MPH, PhD</au><au>Kovesdy, Csaba P., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>70</volume><issue>2</issue><spage>207</spage><epage>217</epage><pages>207-217</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract><![CDATA[Background Mortality is extremely high immediately after the transition to dialysis therapy, but the association of blood pressure (BP) before dialysis therapy initiation with mortality after dialysis therapy initiation remains unknown. Study Design Observational study. Setting & Participants 17,729 US veterans transitioning to dialysis therapy in October 2007 to September 2011, with a median follow-up of 2.0 years. Predictor Systolic (SBP) and diastolic BP (DBP) averaged over the last 1-year predialysis transition period as 6 (<120 to ≥160 mm Hg in 10−mm Hg increments) and 5 (<60 to ≥90 mm Hg in 10−mm Hg increments) categories, respectively, and as continuous measures. Outcomes & Measurements Postdialysis all-cause mortality, assessed over different follow-up periods (ie, <3, 3-<6, 6-<12, and ≥12 months after dialysis therapy initiation) using Cox regressions adjusted for demographics, comorbid conditions, medications, cardiovascular medication adherence, body mass index, estimated glomerular filtration rate, and type of vascular access. Results Mean predialysis SBP and DBP were 141.2 ± 16.1 (SD) and 73.7 ± 10.6 mm Hg, respectively. There was a reverse J-shaped association of SBP with all-cause mortality, with significantly higher mortality seen with SBP < 140 mm Hg. Mortality risks associated with lower SBP were greatest in the first 3 months after dialysis therapy initiation, with multivariable-adjusted HRs of 2.40 (95% CI, 1.96-2.93), 1.99 (95% CI, 1.66-2.40), 1.35 (95% CI, 1.13-1.62), 0.98 (95% CI, 0.78-1.22), and 0.76 (95% CI, 0.57-1.00) for SBP <120, 120 to <130, 130 to <140, 150 to <160, and ≥160 (vs 140-<150) mm Hg, respectively. No consistent association was observed between predialysis DBP and postdialysis mortality. Limitations Results cannot be inferred to show causality and may not be generalizable to women or the general US population. Conclusions Lower predialysis SBP is associated with higher all-cause mortality in the immediate postdialysis period. Predialysis DBP showed no consistent association with postdialysis mortality. Further studies are needed to clarify ideal predialysis SBP levels among incident dialysis patients as a potential means to improve the excessively high early dialysis mortality.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28291617</pmid><doi>10.1053/j.ajkd.2016.12.020</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Blood Pressure Blood pressure (BP) Blood Pressure Determination chronic kidney disease (CKD) dialysis dialysis initiation diastolic BP (DBP) end-stage renal disease (ESRD) Female Humans incident ESRD Kidney Failure, Chronic - mortality Kidney Failure, Chronic - therapy Male mortality Nephrology Renal Dialysis - mortality Retrospective Studies reverse epidemiology risk factor paradox systolic BP (SBP) Time Factors transition transition of care United States Veterans Health |
| title | Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality |
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