Prognostic value of pre-dialysis blood pressure and risk threshold on clinical outcomes in hemodialysis patients: The Q-Cohort Study

Masatoshi Hara, Shigeru Tanaka, Masatomo Taniguchi, Kiichiro Fujisaki, kumiko torisu, Kosuke Masutani, Hideki Hirakata, Toshiaki Nakano, Kazuhiko Tsuruya, Takanari Kitazono

研究成果: ジャーナルへの寄稿記事

抄録

The influence of pre-dialysis blood pressure (BP) on the prognosis of hemodialysis (HD) patients is still inconclusive. A total of 3436 HD patients were prospectively followed up for 4 years. The patients were divided into quintiles of pre-dialysis systolic BP (SBP) and diastolic BP (DBP) levels [mm Hg]: Quintile 1 (Q1), SBP <134, DBP <66; Q2, SBP 134 to 147, DBP 66 to 72; Q3, SBP 148 to 158, DBP 73 to 79; Q4, SBP 159 to 171, DBP 80 to 85; Q5, SBP ≥172, DBP ≥86. The association between the pre-dialysis BP and outcomes were examined using a Cox proportional hazards model. During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed cardiovascular (CV) events. The lowest level of pre-dialysis SBP group (Q1) showed a significantly increased risk of all-cause mortality (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40–2.39) and the highest group (Q5) significantly increased risk of CV events (HR 1.31, 95% CI 1.02–1.68) compared with the reference group (Q3), respectively. The highest level of pre-dialysis DBP group was significantly associated with increased risk for both all-cause mortality and CV events. Restricted cubic spline analysis for BP and outcomes suggested the optimal pre-dialysis BP value associated with the lowest risk of outcomes was SBP 152 mm Hg for all-cause mortality, SBP 143 mm Hg for CV events, and DBP 68 mm Hg for all-cause mortality. Our results suggested that pre-dialysis BP was independently associated with all-cause mortality and CV events among Japanese HD patients.

元の言語英語
記事番号e13485
ジャーナルMedicine (United States)
97
発行部数51
DOI
出版物ステータス出版済み - 12 1 2018

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Renal Dialysis
Dialysis
Cohort Studies
Blood Pressure
Mortality
Confidence Intervals
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Medicine(all)

これを引用

Prognostic value of pre-dialysis blood pressure and risk threshold on clinical outcomes in hemodialysis patients : The Q-Cohort Study. / Hara, Masatoshi; Tanaka, Shigeru; Taniguchi, Masatomo; Fujisaki, Kiichiro; torisu, kumiko; Masutani, Kosuke; Hirakata, Hideki; Nakano, Toshiaki; Tsuruya, Kazuhiko; Kitazono, Takanari.

:: Medicine (United States), 巻 97, 番号 51, e13485, 01.12.2018.

研究成果: ジャーナルへの寄稿記事

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title = "Prognostic value of pre-dialysis blood pressure and risk threshold on clinical outcomes in hemodialysis patients: The Q-Cohort Study",
abstract = "The influence of pre-dialysis blood pressure (BP) on the prognosis of hemodialysis (HD) patients is still inconclusive. A total of 3436 HD patients were prospectively followed up for 4 years. The patients were divided into quintiles of pre-dialysis systolic BP (SBP) and diastolic BP (DBP) levels [mm Hg]: Quintile 1 (Q1), SBP <134, DBP <66; Q2, SBP 134 to 147, DBP 66 to 72; Q3, SBP 148 to 158, DBP 73 to 79; Q4, SBP 159 to 171, DBP 80 to 85; Q5, SBP ≥172, DBP ≥86. The association between the pre-dialysis BP and outcomes were examined using a Cox proportional hazards model. During a 4-year follow-up period, 564 (16.4{\%}) patients died of any cause and 590 (17.2{\%}) developed cardiovascular (CV) events. The lowest level of pre-dialysis SBP group (Q1) showed a significantly increased risk of all-cause mortality (hazard ratio [HR] 1.83, 95{\%} confidence interval [CI] 1.40–2.39) and the highest group (Q5) significantly increased risk of CV events (HR 1.31, 95{\%} CI 1.02–1.68) compared with the reference group (Q3), respectively. The highest level of pre-dialysis DBP group was significantly associated with increased risk for both all-cause mortality and CV events. Restricted cubic spline analysis for BP and outcomes suggested the optimal pre-dialysis BP value associated with the lowest risk of outcomes was SBP 152 mm Hg for all-cause mortality, SBP 143 mm Hg for CV events, and DBP 68 mm Hg for all-cause mortality. Our results suggested that pre-dialysis BP was independently associated with all-cause mortality and CV events among Japanese HD patients.",
author = "Masatoshi Hara and Shigeru Tanaka and Masatomo Taniguchi and Kiichiro Fujisaki and kumiko torisu and Kosuke Masutani and Hideki Hirakata and Toshiaki Nakano and Kazuhiko Tsuruya and Takanari Kitazono",
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T1 - Prognostic value of pre-dialysis blood pressure and risk threshold on clinical outcomes in hemodialysis patients

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AU - Hara, Masatoshi

AU - Tanaka, Shigeru

AU - Taniguchi, Masatomo

AU - Fujisaki, Kiichiro

AU - torisu, kumiko

AU - Masutani, Kosuke

AU - Hirakata, Hideki

AU - Nakano, Toshiaki

AU - Tsuruya, Kazuhiko

AU - Kitazono, Takanari

PY - 2018/12/1

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