Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2010-11, Vol.21 (11), p.1970-1978
Main Authors: MYERS, Orrin B, ADAMS, Christopher, ROHRSCHEIB, Mark R, SERVILLA, Karen S, MISKULIN, Dana, BEDRICK, Edward J, ZAGER, Philip G
Format: Article
Language:English
Subjects:
Adult
African Continental Ancestry Group
Age Factors
Aged
Aged, 80 and over
Biological and medical sciences
Blood Pressure - physiology
Clinical Epidemiology
Cohort Studies
Comorbidity
Continental Population Groups
Diabetes Mellitus - epidemiology
Diabetes Mellitus - ethnology
Diabetes Mellitus - physiopathology
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
European Continental Ancestry Group
Female
Follow-Up Studies
Humans
Hypertension - epidemiology
Hypertension - ethnology
Hypertension - physiopathology
Kidney Failure, Chronic - epidemiology
Kidney Failure, Chronic - ethnology
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Proportional Hazards Models
Renal Dialysis
Risk Factors
Survival Rate
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Summary:Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality. Overall, low SBP associated with increased mortality, and the association was more pronounced among older patients and those with diabetes. Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status. We observed a survival advantage for black patients primarily among older patients. Diabetes associated with increased mortality mainly among older patients with low BP. In conclusion, the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration.
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2010010125