Effect of pre-dialysis blood pressure on all-cause and cardiovascular disease mortality in patients on maintenance hemodialysis
10.3760/cma.j.cn112138-20250307-00130
- VernacularTitle:透析前血压对维持性血液透析患者全因死亡及心血管疾病死亡的影响
- Author:
Congfei WANG
1
;
Bin PAN
1
;
Xishao XIE
1
;
Chunping XU
1
;
Jianghua CHEN
1
;
Ping ZHANG
1
Author Information
1. 浙江大学医学院附属第一医院肾脏病中心 浙江大学肾脏病研究所 浙江省肾脏与泌尿系统疾病临床医学研究中心，杭州 310003
- Publication Type:Journal Article
- Keywords:
Hemodialysis;
Blood pressure;
Cardiovascular disease;
Predialysis blood pressure;
All-cause death
- From:
Chinese Journal of Internal Medicine
2025;64(10):945-953
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of pre-dialysis blood pressure (Pre-BP) on all-cause and cardiovascular disease (CVD) mortality in patients on maintenance hemodialysis (MHD).Methods:This single-center, retrospective cohort study enrolled patients undergoing first-time hemodialysis between January 1, 2007, and June 30, 2021, from the dialysis registry of the First Affiliated Hospital, Zhejiang University School of Medicine. General information and laboratory parameters were collected. Pre-dialysis systolic blood pressure (Pre-SBP) and pre-dialysis diastolic blood pressure (Pre-DBP) were calculated and averaged at 4-6 months after dialysis. The mean Pre-SBP and Pre-DBP values were used as continuous variables, and restricted cubic spline (RCS) curves were used to assess the relationship between Pre-BP and mortality risk. Patients were subsequently divided into six groups for Pre-DBP and six groups for Pre-SBP combined with Pre-DBP. Survival analyses were performed using the Kaplan-Meier method. All-cause and CVD mortality were compared between groups using the log-rank test. Multivariate Cox regression models were used to analyze the associations between Pre-BP and all-cause and CVD mortality.Results:A total of 1 213 patients were enrolled. By the end of follow-up, 175 patients (14.4%) had died, of whom 62 (35.4%) died from CVD. Kaplan-Meier survival curves showed that the Pre-DBP<65 mmHg group (1 mmHg=0.133 kPa) had a significantly lower cumulative survival rate ( χ2=90.52, P<0.001) and a significantly higher CVD mortality rate ( χ2=35.54, P<0.001) than the other groups. The combined Pre-SBP and Pre-DBP analysis showed that the Pre-SBP≥150 mmHg and Pre-DBP<80 mmHg groups had a significantly lower cumulative survival rate ( χ2=45.58, P<0.001) and a significantly higher CVD mortality rate ( χ2=30.13, P<0.001) than the other groups. Multivariate Cox regression model analysis showed that compared with other groups, the risk of MHD all-cause mortality was increased in the Pre-DBP<65 mmHg group and the Pre-SBP≥150 mmHg and Pre-DBP<80 mmHg group [ HR (95% CI)=1.927 (1.195-3.109), 3.298 (1.567-6.939), both P<0.05]. Conclusion:In patients undergoing MHD, Pre-DBP<65 mmHg or Pre-SBP≥150 mmHg and Pre-DBP<80 mmHg were independent risk factors for all-cause mortality, with a low cumulative survival rate and a high risk of CVD mortality.
