Document Detail


Blood pressure and mortality among hemodialysis patients.
MedLine Citation:
PMID:  20083728     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Blood pressure measured before and after dialysis does not agree well with those recorded outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of greater prognostic value than blood pressure obtained just before and after dialysis remains incompletely understood. Among 326 patients on long-term hemodialysis, blood pressure was self-measured at home for 1 week, over an interdialytic interval by ambulatory recording and before and after dialysis over 2 weeks. Over a mean follow-up of 32 (SD 20) months, 102 patients died (31%), yielding a crude mortality rate of 118/1000 patient years. Systolic but not diastolic blood pressure was found to be of prognostic importance. Adjusted and unadjusted multivariate analyses showed increasing quartiles of ambulatory and home systolic blood pressure to be associated with all-cause mortality (adjusted hazard ratios for increasing quartiles of ambulatory: 2.51, 3.43, 2.62; and for home blood pressure: 2.15, 1.7, 1.44). Mortality was lowest when home systolic blood pressure was between 120 to 130 mm Hg and ambulatory systolic blood pressure was between 110 to 120 mm Hg. Blood pressure recorded before and after dialysis was not statistically significant (P=0.17 for predialysis, and P=0.997 for postdialysis) in predicting mortality. Out-of-dialysis unit blood pressure measurement provided superior prognostic information compared to blood pressure within the dialysis unit (likelihood ratio test, P<0.05). Out-of-dialysis unit blood pressure among hemodialysis patients is prognostically more informative than that recorded just before and after dialysis. Therefore, the management of hypertension among these patients should focus on blood pressure recordings outside the dialysis unit.
Authors:
Rajiv Agarwal
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-01-18
Journal Detail:
Title:  Hypertension     Volume:  55     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-19     Completed Date:  2010-03-18     Revised Date:  2014-09-14    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  762-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure*
Blood Pressure Monitoring, Ambulatory / mortality*
Cohort Studies
Female
Follow-Up Studies
Humans
Hypertension, Renal / diagnosis*,  mortality*
Kaplan-Meier Estimate
Kidney Failure, Chronic / mortality*,  therapy
Male
Middle Aged
Morbidity
Nonlinear Dynamics
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Renal Dialysis / mortality*
Grant Support
ID/Acronym/Agency:
2R01-DK062030-06A109/DK/NIDDK NIH HHS; R01 DK062030/DK/NIDDK NIH HHS; R01 DK062030-06A1/DK/NIDDK NIH HHS
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