Document Detail


Prognostic value of 24-hour ambulatory blood pressure monitoring and of night/day ratio in nondiabetic, cardiovascular events-free hemodialysis patients.
MedLine Citation:
PMID:  16105064     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The use of 24-hour ambulatory blood pressure monitoring is increasing in end-stage renal disease (ESRD) patients but the prediction power for cardiovascular complications of time-averaged ambulatory blood pressure components has been little investigated in these patients. METHODS: We analyzed the prognostic power of 24-hour ambulatory blood pressure monitoring for all-cause and cardiovascular mortality in 168 nondiabetic, events-free hemodialysis patients selected from a total dialysis population of about 450 patients. RESULTS: During the follow-up period (38 +/- 22 months), 48 patients died, 29 of them of cardiovascular causes. On univariate Cox regression analyses, the night/day systolic ratio resulted to be the sole blood pressure indicator to be associated with all-cause and cardiovascular mortality while left ventricular hypertrophy (LVH) was a strong predictor of these outcomes. In multivariable Cox models not including LVH, the night/day systolic ratio maintained an independent prognostic value for incident outcomes. However, when both risk factors, LVH and night/day systolic ratio, were introduced into Cox models, LVH was no longer a significant predictor while the night/day systolic ratio became a predictor of marginal statistical significance. CONCLUSION: The night/day ratio emerges as the sole ambulatory blood pressure monitoring-derived indicator providing significant prognostic information in patients with ESRD. However, this indicator as well as LVH loses substantial prediction power in statistical models including both risk factors. The results suggest that the night/day systolic ratio and LVH provide overlapping prognostic information, a phenomenon in keeping with the hypothesis that they represent a common pathway leading to adverse outcomes in ESRD.
Authors:
Giovanni Tripepi; Riccardo Maria Fagugli; Pietro Dattolo; Giovanna Parlongo; Francesca Mallamaci; Umberto Buoncristiani; Carmine Zoccali
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Kidney international     Volume:  68     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-17     Completed Date:  2006-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1294-302     Citation Subset:  IM    
Affiliation:
CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension, Reggio Cal, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Blood Pressure Monitoring, Ambulatory*
Circadian Rhythm
Female
Follow-Up Studies
Humans
Hypertension, Renal / diagnosis*,  mortality*
Hypertrophy, Left Ventricular / mortality
Kidney Failure, Chronic / mortality*,  therapy
Male
Middle Aged
Multivariate Analysis
Prevalence
Prognosis
Proportional Hazards Models
ROC Curve
Renal Dialysis / mortality*
Risk Factors

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


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