Abstract: FR-PO744
Impact of Blood Pressure on Mortality in Patients Undergoing Peritoneal Dialysis
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Kim, Jwa-kyung, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
- Lee, Dong Hee, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
- Kim, Sungmin, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
- Kim, Sung Gyun, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
Background
A recent KDIGO guideline recommends intensive blood pressure (BP) control in chronic kidney disease. However, no consensus on the optimal BP has been made in the dialysis population. With a well-characterized peritoneal dialysis (PD) cohort, we evaluated the impact of BP on long-term mortality.
Methods
With the incident PD patients who had more than 6 months' follow-up between 2000 to 2019 (n=490), the relationship between BP and mortality rate adjusting for age, sex, BMI, and comorbidities was analyzed. Mean BP levels at 3-6 months after PD initiation were studied for predicting all-cause mortality as well as fatal and non-fatal cardiovascular (CV) events.
Results
During the median PD duration of 40 months (IQR, 22 to 66), the mortality rate was 50.3 per 1000 patient-year (102 cases). Overall, the survival rates were much better than previously known; the 3-. 5- and 10-year patient survival rate was 87.6%, 79.1%, and 55.4%. It markedly differed according to the presence of diabetes; the 3, 5, and 10-year mortality were 84%, 71.4%, and 40.7% in diabetes and 92%, 89.0 %, and 74% in non-diabetes, respectively (p<0.001). In multivariate Cox proportional hazard modeling, the risk of death had a U-curved association with systolic BP (SBP) with a nadir between 120 and 140 mmHg. Based on this, the hazard ratios (HR, 95% confidence interval [CI]) for all-cause mortality with SBP <120 mmHg, 140-160 mmHg, and ≥160 mmHg were 3.3 (1.7-6.4), 1.68 (0.83-3.4), and 2.3 (1.1-4.9) after adjusting age, sex, diabetes, body mass index, and previous coronary artery diseases. Similarly, fatal and non-fatal CV risks were significantly increased when SBP <120 mmHg or ≥160 mmHg.
Conclusion
Patients who started PD in the 2000s showed improved survival rates than before. Low SBP < 120 mmHg showed the highest mortality risk. And high SBP > 160 mmHg was also associated with increased mortality even after adjusting for well-known risk factors.