| Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease. | |
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MedLine Citation:
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PMID: 16421161 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Blood pressure shows an inverse association with mortality in patients with chronic kidney disease (CKD) on dialysis. It is unclear if the same phenomenon exists in patients with CKD not yet on dialysis. METHODS: We examined the association of systolic (SBP) and diastolic (DBP) blood pressure with all-cause mortality in a historical prospective cohort of 860 patients (age 68.1+/-10.1 years, 99.1% male, 24.4% black) with estimated glomerular filtration rate (GFR) < 60 ml/min/1.73 m2. We used Cox models to adjust for the effects of age, race, diabetes mellitus, atherosclerotic cardiovascular disease (ASCVD), congestive heart failure, smoking, antihypertensive medications, body mass index, GFR, albumin, cholesterol, haemoglobin and proteinuria. To examine the role of comorbidities, we performed subgroup analyses based on prevalent ASCVD status and level of estimated GFR. RESULTS: Higher SBP and higher DBP were both associated with lower mortality [adjusted hazard ratio (95% confidence interval) for SBP 133-154, 155-170 and > 170 mmHg, compared with < 133 mmHg, respectively: 0.61 (0.44-0.85), 0.62 (0.45-0.87) and 0.68 (0.49-0.96); and for DBP 65-75, 76-86 and > 86 mmHg, compared with < 65 mmHg: 0.85 (0.62-1.18), 0.72 (0.52-1.00) and 0.60 (0.41-0.86)]. The same association was present for both SBP and DBP only in subgroups with GFR < or = 30 ml/min/1.73 m2 and for DBP only in the subgroup with ASCVD. CONCLUSIONS: Lower blood pressure is associated with higher mortality in patients with moderate to severe CKD, but interactions with kidney function and with ASCVD suggest that blood pressure may play a surrogate rather than a causative role in this association. |
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Authors:
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Csaba P Kovesdy; Bhairvi K Trivedi; Kamyar Kalantar-Zadeh; John E Anderson |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2006-01-18 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 21 ISSN: 0931-0509 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2006 May |
Date Detail:
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Created Date: 2006-04-20 Completed Date: 2006-07-07 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 1257-62 Citation Subset: IM |
Affiliation:
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Division of Nephrology, Salem VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153, USA. csaba.kovesdy@med.va.gov |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Distribution Aged Aged, 80 and over Blood Pressure Determination Cause of Death* Cohort Studies Comorbidity Female Glomerular Filtration Rate Humans Hypotension / diagnosis, epidemiology* Kidney Failure, Chronic / diagnosis, epidemiology*, therapy Kidney Function Tests Male Middle Aged Probability Prognosis Proportional Hazards Models Prospective Studies Renal Dialysis Risk Assessment Severity of Illness Index Sex Distribution Survival Analysis |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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