title: Reverse Epidemiology of Blood Pressure in Peritoneal Dialysis Associated with Dynamic Deterioration of Left Ventricular Function.
abstract: ♦
  
  
  BACKGROUND
  Reverse epidemiology of blood pressure (BP) in end-stage kidney disease (ESKD) is manifested as higher mortality at lower blood pressure. We hypothesize that this phenomenon is partially mediated by deterioration of cardiac structure and function. ♦
  
  
  METHODS
  Seventy-seven prevalent ESKD patients starting renal replacement therapy on peritoneal dialysis (PD) from 2007 to 2012 were evaluated for the primary outcome of all-cause mortality. Longitudinal data were obtained from 1,930 patient-encounters including monthly clinic BP and serial echocardiograms. Generalized linear mixed models using data from the last observation moving backward, and time-to-event analysis using time-varying Cox-survival models to estimate mortality risk at different blood pressure categories were applied. ♦
  
  
  RESULTS
  There were 39 males (50.6%). Mean age was 51 years (standard deviation [SD] = 15). During follow-up, 20 patients (25%) died. As compared to systolic blood pressure (SBP) of 140-159 mmHg, unadjusted risk of mortality was 7.3 (95% confidence interval [CI]: 1.5-35.7, p = 0.008) at level < 120 mmHg. Systolic BP trended down to an average of 117 mmHg prior to death in non-survivors as compared to 141 mmHg in survivors (p < 0.05). In non-survivors, percentage with concentric left ventricular hypertrophy (LVH) decreased by 20% at the expense of a 20% reciprocal increase in eccentric hypertrophy associated with a 30% increase in percentage with low ejection fraction (EF) (< 50%). After adjusting for EF, risk of mortality at SBP < 120 mmHg attenuated to 3.4 (95% CI: 0.7-17.7, p = 0.14). ♦
  
  
  CONCLUSIONS
  We conclude that higher mortality associated with lower BP may be mediated in part by worsening heart function in ESKD patients receiving PD.
authors: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States fafshin@med.umich.edu.
authors: Farsad
authors: F
authors: Afshinnia
authors: Division of Nephrology, Glickman Urology & Nephrology Institute, Cleveland Clinic, Ohio, United States.
authors: Ziad S
authors: ZS
authors: Zaky
authors: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
authors: Manasa
authors: M
authors: Metireddy
authors: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
authors: Jonathan H
authors: JH
authors: Segal
mesh_terms: D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D016277:Ventricular Function, Left
keywords: Peritoneal dialysis; blood pressure; end-stage kidney disease; heart failure; mortality