Document Detail

Blood pressure and survival in long-term hemodialysis patients with and without polycystic kidney disease.
MedLine Citation:
PMID:  20720499     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In maintenance dialysis patients, low blood pressure (BP) values are associated with higher death rates when compared with normal to moderately high values. This 'hypertension paradox' may be related to comorbid conditions. Dialysis patients with polycystic kidney disease (PKD) usually have a lower comorbidity burden and greater survival. We hypothesized that in PKD dialysis patients, a representative of a healthier dialysis patient population, high BP is associated with higher mortality.
METHODS: Time-dependent survival models including after multivariate adjustment were examined to assess the association between prehemodialysis and posthemodialysis BP and all-cause mortality in a 5-year cohort of 67 085 non-PKD and 1579 PKD hemodialysis patients.
RESULTS: In PKD patients, low prehemodialysis and posthemodialysis SBPs were associated with increased mortality, whereas high prehemodialysis DBP was associated with greater survival. Fully adjusted death hazard ratios (and 95% confidence levels) for prehemodialysis and posthemodialysis BP of less than 120 mmHg (reference 140 to <160 mmHg) were 1.30 (1.06-1.92) and 1.45 (1.04-2.02), respectively, and for prehemodialysis DBP of 80 mmHg or more (reference 70 to <80 mmHg) was 0.68 (0.49-0.93, all P values <0.05). Similar associations were observed in non-PKD patients. In pooled analyses, within each commensurate BP stratum, PKD patients exhibited superior survival to non-PKD patients.
CONCLUSION: Among hemodialysis patients, those with PKD display a similar BP paradox as those without PKD, even though within each BP category PKD patients maintain superior survival. Randomized clinical trials are needed to define optimal blood pressure targets in the hemodialysis population.
Miklos Z Molnar; Lilia R Lukowsky; Elani Streja; Ramanath Dukkipati; Jennie Jing; Allen R Nissenson; Csaba P Kovesdy; Kamyar Kalantar-Zadeh
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  28     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2011-01-26     Completed Date:  2011-05-24     Revised Date:  2014-09-14    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  2475-84     Citation Subset:  IM    
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MeSH Terms
Blood Pressure*
Case-Control Studies
Cohort Studies
Polycystic Kidney Diseases / physiopathology*
Renal Dialysis*
Survival Analysis*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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