“U” curve association of blood pressure and mortality in hemodialysis patients

Zager, Philip G.; Nikolic, Jovanka; Brown, R. H.; Campbell, Marilyn; Hunt, William C.; Peterson, Darwin W.; Stone, John Van; Levey, Andrew S.; Meyer, Klemens B.; Klag, Michael J.; Johnson, Howard; Clark, Eugene; Sadler, John H.; Teredesai, Pradip

doi:10.1046/j.1523-1755.1998.00005.x

Cited by 594 publications

(457 citation statements)

References 40 publications

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“…There is no doubt that, at least in the long term, hypertension is a powerful predictor of mortality for patients who are on hemodialysis (16), despite that in patients with cardiovascular damage low BP rather than high BP is associated with higher mortality (17). In the first article ever on maintenance hemodialysis, Scribner, a prophet in the desert, stated (18): "In the case of dialysis patients a low normal level of ECV is maintained by the powerful tool of ultrafiltration which, if properly used along with moderate dietary sodium restriction and maintenance of natriuresis by diuretics (19), are the only proven method of controlling BP in the hemodialysis population."…”

Section: Salt and Salt-mediated Hormonesmentioning

confidence: 99%

“…Observational studies in prevalent dialysis populations yielded controversial results: Low BP values were associated with the highest risk (17,94). Studies of patients who had less morbidity and were on long, slow dialysis clearly showed that low BP values within the normal range provided a survival benefit (16).…”

Section: Attractive Areas For Future Investigationsmentioning

confidence: 99%

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Cardiovascular Problems on Hemodialysis

Ritz

Bommer

2009

Clinical Journal of the American Society of Nephrology

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Section: Salt and Salt-mediated Hormonesmentioning

confidence: 99%

Section: Attractive Areas For Future Investigationsmentioning

confidence: 99%

Cardiovascular Problems on Hemodialysis

Ritz

Bommer

2009

Clinical Journal of the American Society of Nephrology

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“…Both decreasing DBP (the principal moving force for coronary perfusion) (25) and increasing PP (26) are associated with poor survival in hemodialysis patients (24). However, high postdialysis DBP of 90 mmHg or greater has also been associated with increased cardiovascular mortality (27). Evidence suggests that there is also a "U" curve relationship between postdialysis SBP and cardiovascular mortality in hemodialysis patients, with pressures of 180 mmHg or greater and Ͻ110 mmHg being associated with increased mortality (27).…”

Section: Clinical Impact Of Calcificationmentioning

confidence: 99%

“…However, high postdialysis DBP of 90 mmHg or greater has also been associated with increased cardiovascular mortality (27). Evidence suggests that there is also a "U" curve relationship between postdialysis SBP and cardiovascular mortality in hemodialysis patients, with pressures of 180 mmHg or greater and Ͻ110 mmHg being associated with increased mortality (27). The association of increased mortality with lower SBP is most probably the result of LV dysfunction and chronic heart failure, not of lower pressure as such.…”

Section: Clinical Impact Of Calcificationmentioning

confidence: 99%

Cardiovascular Calcifications in Uremic Patients

London

2003

Journal of the American Society of Nephrology

192

136

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Abstract. Cardiovascular disease is the leading cause of mortality among patients with ESRD (chronic kidney disease stage 5). Left ventricular hypertrophy and arterial diseases are the two principal risk factors for cardiovascular mortality in hemodialysis patients. Epidemiologic studies show that damage to large conduit arteries contributes to morbidity and mortality in patients with chronic kidney disease. Atherosclerosis is primarily an intimal disease characterized by the presence of plaques and occlusive lesions. Although atherosclerosis is the most frequent underlying cause of cardiovascular disease in patients with ESRD, it represents only one form of structural response to metabolic and hemodynamic alterations that interfere with the process of aging. Arterial alterations in ESRD include nonocclusive arterial remodeling accompanying the growing hemodynamic burden and humoral abnormalities that are associated with chronic uremia. The consequences of these alterations are different from those attributed to atherosclerotic plaques and are characterized principally by hardening (stiffening) of arteries. Arteriosclerosis, characterized by stiffening of the aorta and large capacitative arteries, is a major determinant of left ventricular pressure overload and of abnormal coronary perfusion. Atherosclerosis and arteriosclerosis are frequently comorbid and characterized by a high degree of both intimal and medial calcifications in patients with ESRD. The extent of calcifications and the degree of arterial stiffening are independent predictors of mortality. Studies in patients with ESRD have shown that attenuation of arterial stiffness can have a favorable effect, associated with regression of left ventricular hypertrophy, on survival. Calciumfree, metal-free phosphate binders such as sevelamer can reduce calcification scores.

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“…Low predialysis systolic BP (o110 mmHg) and low predialysis diastolic BP (o70 mmHg) are associated with increased mortality, primarily because of severe congestive heart failure or coronary artery disease. 5 Optimal BP in dialysis patients is not different from recommendations for the general population, even though definite evidence is not yet available.…”

Section: Introductionmentioning

confidence: 99%

Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients

Roguljic¹,

Kovačić²,

Bačić

et al. 2003

J Hum Hypertens

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The mean arterial pressure (MAP) usually serves as an expression of blood pressure in patients on chronic haemodialysis (PCHD), instead of using solely systolic or diastolic pressure. Pulse pressure (PP) has been recognized as an important correlate of mortality in PCHD. We conducted this study in order to demonstrate clinical and biochemical determinants and variability of predialysis and postdialysis MAP and PP values. A total of 136 single haemodialysis (HD) treatments in 23 subjects (PCHD, 11 male and 12 female patients) were processed during 15 months. MAP before HD was in negative correlation with haemoglobin (Po0.001) and body mass index (BMI) (Po0.001), and in positive correlation with weekly erythropoietin dosage (P ¼ 0.017). MAP after HD was in negative correlation with haemoglobin (Po0.001), ultrafiltration per HD (P ¼ 0.015), and BMI (P ¼ 0.001), and in positive correlation with weekly erythropoietin dosage (P ¼ 0.003). PP before HD was in negative correlation with parathyroid hormone (PTH) level (P ¼ 0.020), haemoglobin (Po0.001), ultrafiltration per HD (P ¼ 0.001), and years on the chronic HD treatment (P ¼ 0.001), and in positive correlation with weekly erythropoietin dosage (Po0.001) and age (Po0.001). PP after HD was in significant negative correlation with PTH (P ¼ 0.015), haemoglobin (P ¼ 0.005), ultrafiltration per HD (Po0.001), BMI (P ¼ 0.003), and in positive correlation with weekly erythropoietin dosage (Po0.001) and age (P ¼ 0.004). Multiple regression analyses unveiled the strongest and negative correlations between MAP before HD and BMI (b ¼ À0.37, P ¼ 0.01); MAP after HD and haemoglobin (b ¼ À0.36, P ¼ 0.01); PP after HD and ultrafiltration/body weight ratio (b ¼ À0.41, Po0.001).

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“U” curve association of blood pressure and mortality in hemodialysis patients

Abstract: The results suggest the presence of a "U" curve relationship between SBP post-dialysis and CV mortality in HD patients.

Cited by 594 publications

References 40 publications

Cardiovascular Problems on Hemodialysis

Cardiovascular Problems on Hemodialysis

Cardiovascular Calcifications in Uremic Patients

Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients

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