The association between pulse pressure and vascular access thrombosis in chronic hemodialysis patients.
Vascular access thrombosis (VAT) is a major cause of morbidity in chronic hemodialysis (HD) patients and is characterized by chronic inflammation. Pulse pressure (PP) is positively associated with chronic inflammation. Whether patients with high PP are at a higher risk for VAT, however, remains unknown. We retrospectively reviewed chronic HD patients with a functional vascular access point at the China Medical University Hospital between 1986 and 2005. The association between PP and the initial development of VAT at the primary vascular access point was examined using the Kaplan-Meier analysis and multivariate Cox proportional hazards regression. A total of 576 chronic HD patients (264 men and 312 women) with a mean age of 56.9+/-14.0 years were reviewed, of whom 145 (25.2%) experienced at least one episode of VAT. Patients with a PP>60 mm Hg had a lower VAT-free survival rate compared with those with a PP<60 mm Hg (P<0.001). Using Cox regression with adjustments for age, systolic blood pressure and vascular access types, PP (every increase of 10 mm Hg) and serum C-reactive protein (CRP) (every increase of 1 mg per 100 ml) were found to be independently associated with an increasing risk for VAT, with a hazard ratio of 2.57 (95% confidence interval: 1.5-4.4, P=0.001) and 1.14 (95% confidence interval: 1.01-1.27, P=0.017), respectively. High PP was associated with the development of VAT in chronic HD patients. This association was independent of serum CRP levels.
Chou
Che-Yi
CY
Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung 40461, Taiwan.
Liu
Jiung-Hsiun
JH
Kuo
Huey-Liang
HL
Liu
Yao-Lung
YL
Lin
Hsin-Hung
HH
Yang
Ya-Fei
YF
Wang
Shu-Ming
SM
Huang
Chiu-Ching
CC
D000368:Aged; D000375:Aging / Q000502:physiology; D015415:Biomarkers; D001794:Blood Pressure / Q000502:physiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology / Q000503:physiopathology*
D015415:Biomarkers