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The associations of blood pressure parameters with all-cause and cardiovascular mortality in peritoneal dialysis patients: a cohort study in China

Lookup NU author(s): Dr Haiyan ZhengORCiD

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Abstract

Background It remains controversial to claim blood pressure (BP) as a leading risk factor for high risk of death in peritoneal dialysis (PD) patients, and less is known about the relationship between BP and mortality in Chinese PD patients. Methods From Zhejiang Renal Data System in China, we collected data on patients treated and followed up at 98 PD centers from 2008 to 2016. The associations of BP parameters (systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP)) with all-cause and cardiovascular mortality were examined. We fitted Cox models for mortality with penalized splines using non-parametric smoothers. Several sensitivity analyses were performed to confirm the robustness of our primary findings. Results A total of 7335 Chinese PD patients were included. During a median follow-up of 35.8 months, 1281 (17.5%) patients died. SBP, DBP, MAP follow a U-shaped pattern of both all-cause and cardiovascular mortality. PP presents a reverse L-shaped association with all-cause mortality. Either a higher (SBP > 141, DBP > 85, or MAP > 102 mm Hg) or lower (SBP < 119, DBP < 67, or MAP < 88 mm Hg) blood pressure tends to have a significantly higher all-cause and cardiovascular mortality risk. Higher PP (> 60 mm Hg) is related to a higher risk of all-cause mortality, but not cardiovascular mortality. These associations remain the same in our competing risk analysis and subgroup analyses. Conclusions This data indicates U-shaped associations of SBP, DBP and MAP with all-cause mortality and cardiovascular mortality, respectively, and a reverse L-shaped association of PP with all-cause mortality. Further studies are needed to reliably establish the optimal BP targets for better hypertension control in PD patients.

Publication metadata

Author(s): Xie X, Lv D, Zheng H, Zhang X, Han F, Chen J

Publication type: Article

Publication status: Published

Journal: Journal of Hypertension

Year: 2020

Volume: 38

Issue: 11

Pages: 2252-2260

Print publication date: 01/11/2020

Online publication date: 25/06/2020

Acceptance date: 05/05/2020

ISSN (print): 0263-6352

ISSN (electronic): 1473-5598

Publisher: Lippincott Williams & Wilkins

URL: https://doi.org/10.1097/hjh.0000000000002526

DOI: 10.1097/hjh.0000000000002526

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