Hypertension as a determinant of survival for patients treated with home dialysis

✍ Scribed by Lynn, Kelvin L.; McGregor, David O.; Moesbergen, Todd; Buttimore, Adrian L.; Inkster, Judith A.; Wells, J. Elisabeth

• Publisher: Nature Publishing Group
• Year: 2002
• Tongue: English
• Weight: 130 KB
• Volume: 62
• Category: Article
• ISSN: 0085-2538
• DOI: 10.1046/j.1523-1755.2002.00685.x

✦ Synopsis

Background:

Previous studies of the risks of hypertension for dialysis patients have yielded conflicting results. the aim of this study was to investigate, in a home dialysis population with low rates of diabetes and antihypertensive drug use, whether blood pressure (bp) was an independent risk factor for survival.

Methods:

The outcome of 168 consecutive patients (94 male, 88% caucasian), aged 48 years (sd 16), who began home hemodialysis (hd; n = 124) or home continuous ambulatory peritoneal dialysis (capd; n = 44) between january 1, 1985 and december 31, 1994 were analyzed retrospectively. only 4.7% of patients took antihypertensive drugs while on dialysis. the patients were followed to december 31, 1998 with the primary outcome being all-cause mortality. censoring events were transplantation, transfer to another center and treatment modality change. the cox proportional hazard model was used with baseline predictors.

Results:

Seventy-one patients died and the median overall survival was 4.2 years (5.6 on hd, 2.2 on capd, p < 0.0001). mean bp at start of dialysis predicted survival on its own (p = 0.0009) and in the joint cox model (p = 0.047). other significant predictors in the joint model were age [10 year increase, relative hazard (rh) = 1.55, p = 0.0008], albumin (10 g/l decrease, rh = 2.05, p = 0.007), diabetes (rh = 3.42, p = 0.015) and peripheral vascular disease (rh = 2.19, p = 0.02) but not dialysis modality (rh = 1.63, p = 0.13). high and low mean blood pressure (bp) values at the start of dialysis were associated with the highest mortality.

Conclusions:

Among the home dialysis patients, most of whom did not require antihypertensive drugs, hypertension was a risk factor for survival and patients with mid-range bp values survived the longest.