Association of blood pressure with the start of renal replacement therapy in elderly compared with young patients receiving predialysis care.
BACKGROUND
In the growing elderly predialysis population, little is known about the effect of identified risk factors on the progression to end-stage renal disease. Therefore, we investigated the association of systolic (SBP) and diastolic blood pressure (DBP) with the start of renal replacement therapy (RRT), in elderly (≥65 years) compared with young (<65 years) predialysis patients.


METHODS
In the PREPARE-1 cohort, 547 incident predialysis patients, referred as part of the usual care to eight Dutch predialysis care outpatient clinics, were included (1999-2001) and followed until the start of dialysis, transplantation, death, or until 1 January 2008. The outcome was the start of RRT. All analyses were stratified for age; <65 years (young) and ≥65 years (elderly).


RESULTS
In young predialysis patients (n = 268) higher SBP (every 20 mm Hg increase) and high DBP (DBP ≥100 mm Hg compared with 80-89 mm Hg) were associated with a higher rate of starting RRT (adjusted hazard ratio (HR) (95% confidence interval) 1.21 (1.09;1.34) and 1.74 (1.16;2.62), respectively). However, in elderly predialysis patients (n = 240) only patients with SBP ≥180 mm Hg had an increased rate compared with patients with 140-159 mm Hg (adjusted HR 2.33 (1.41;3.87)). Furthermore, patients with DBP <70 or ≥100 mm Hg had an increased rate of starting RRT, independent of SBP, compared with patients with 80-89 mm Hg (fully adjusted HR 1.72 (1.01;2.94) and 2.05 (1.13;3.73), respectively).


CONCLUSIONS
The association of SBP and DBP with the start of RRT is different between elderly and young predialysis patients.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Moniek C M
MC
de Goeij
Dinanda J
DJ
de Jager
Diana C
DC
Grootendorst
Nora
N
Voormolen
Yvo W J
YW
Sijpkens
Sandra
S
van Dijk
Ellen K
EK
Hoogeveen
Jeroen P
JP
Kooman
Elisabeth W
EW
Boeschoten
Friedo W
FW
Dekker
Nynke
N
Halbesma
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy
D000959:Antihypertensive Agents