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 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.
University of New Mexico Health Sciences Center, Albuquerque, NM 87131-5271, USA.
Orrin B
OB
Myers
Christopher
C
Adams
Mark R
MR
Rohrscheib
Karen S
KS
Servilla
Dana
D
Miskulin
Edward J
EJ
Bedrick
Philip G
PG
Zager
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D044469:Racial Groups; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D044465:White People