Association between pulse pressure and 30-month all-cause mortality in peritoneal dialysis patients.
BACKGROUND
Pulse pressure (PP) is an independent predictor of cardiovascular and/or all-cause mortality in patients with underlying cardiovascular disease. We examined whether PP can be used to predict overall mortality in peritoneal dialysis (PD) patients.


METHODS
We studied 153 PD patients (mean age, 54.5 +/- 14.2 years) with end-stage renal disease. PP was measured monthly for 3 months. At the time of the third PP measurement, baseline demographic, clinical, biochemical, and dialysis data were collected. Patients were stratified into tertiles according to average PP, and the relationship between blood pressure parameters and all-cause mortality over a 30-month follow-up was assessed using Cox regression.


RESULTS
There were 27 deaths; three deaths occurred after the change to hemodialysis (HD) (subjects died within 3 months after HD) and were counted as events during survival analysis. The overall 30-month survival (Kaplan-Meier curves) times were significantly different among the tertiles of PP (P < 0.05). Increased PP was significantly associated with overall mortality regardless of adjustment for systolic blood pressure (SBP) or diastolic blood pressure (DBP).


CONCLUSIONS
PP may be the most consistent blood pressure indicator of mortality risk. All-cause mortality events in PD patients are more related to pulsatile stress caused by the stiffness of large arteries during systole (reflected in a rise of PP) than to steady-state stress stemming from resistance during diastole (reflected in a rise of SBP and DBP).
Liu
Jiung-Hsiun
JH
Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Chen
Ching-Chu
CC
Wang
Shu-Ming
SM
Chou
Che-Yi
CY
Liu
Yao-Lung
YL
Kuo
Huey-Liang
HL
Lin
Hsin-Hung
HH
Wang
I-Kuan
IK
Yang
Ya-Fei
YF
Huang
Chiu-Ching
CC
D000368:Aged; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013624:Taiwan