Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Navaneethan, Sankar D.; Schold, Jesse D.; Jolly, Stacey E.; Arrigain, Susana; Blum, Matthew F.; Winkelmayer, Wolfgang C.; Nally, Joseph V.

doi:10.1016/j.kint.2017.04.030

Cited by 34 publications

(24 citation statements)

References 36 publications

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“…In this study, reduced myocardial perfusion was predominantly considered to be a result of reduced microcirculatory blood flow rather than flow in the major epicardial vessels; specific mechanisms are yet to be identified. These data and others provide strong evidence of acute and chronic cardiac dysfunction during and further to HD treatment [ 6 , 8 , 9 , 11 , 17 , 18 , 24 – 26 , 33 , 34 ]. The investigation of methods to counteract these hemodynamic perturbations appears critical for both patient quality of life and survival.…”

Section: Systemic Effectssupporting

confidence: 53%

Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise

McGuire

Horton

Renshaw

et al. 2018

BioMed Research International

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Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20–30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD.

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Section: Systemic Effectssupporting

confidence: 53%

Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise

McGuire

Horton

Renshaw

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…Blood pressure categories. We classified SBP as <100 mm Hg, 100 to 119 mm Hg (reference), 120 to 139 mm Hg, and ≥140 mm Hg (7,22), and DBP as <70 mm Hg, 70 to 79 mm Hg (reference), 80 to 89 mm Hg, and ≥90 mm Hg (23). To better characterize actual blood pressure levels and to evaluate the sex-specific association of blood pressure with all-cause mortality, we further classified study participants into 4 groups according to the 2017 US hypertension guidelines (11): normal blood pressure (SBP <120 mm Hg and DBP <80 mm Hg), elevated blood pressure (SBP 120-129 mm Hg and DBP <80 mm Hg), stage 1 hypertension (SBP 130-139 mm Hg or DBP 80-89 mm Hg), and stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg).…”

Section: Study Participantsmentioning

confidence: 99%

Sex-Specific Association of Blood Pressure Categories With All-Cause Mortality: The Rural Chinese Cohort Study

et al. 2020

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What is already known on this topic? Increased risk of all-cause mortality is associated with nonoptimal blood pressure. However, studies of the relationship between blood pressure categories and all-cause mortality in the Chinese adult population are limited, and sex-specific studies of these associations are not available. Furthermore, the relationship between the 2017 US hypertension guidelines and all-cause mortality in China is unclear. What is added by this report? Results of our prospective study, in a rural Chinese population, showed that risk of all-cause mortality with hypertension based on the 2017 US hypertension guidelines was increased for men but not women. What are the implications for public health practice? Treatment for hypertension should rely on clinicians' cautious judgment about whether and when to start treatment. In addition, antihypertension goals may need to be individualized for people with different characteristics.

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“…While we obtained cause-specific death data, this information was derived from death certificates, which is subject to limitations. However, we had previously validated the reliability of the cause-specific death data for other, previous studies [43,44].…”

Section: Discussionmentioning

confidence: 97%

Cause-Specific Mortality in Patients with Chronic Kidney Disease and Atrial Fibrillation

et al. 2018

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Background: Atrial fibrillation (AF) is associated with death in patients with chronic kidney disease (CKD). We examined the associations between AF and cause-specific mortality in a large CKD population. Methods: We included 62,459 patients with estimated glomerular filtration rate 15–59 mL/min/1.73 m² (6,639 patients with AF and 55,820 without AF) followed in a large health care system. Outcomes included overall and cause-specific deaths (a) cardiovascular; (b) malignancy; and (c) non-cardiovascular/non-malignancy causes. Cox regression models for overall mortality and separate competing risk models for each major cause of death category were used to evaluate their respective associations with AF. Results: During a median follow-up of 4.1 years, 19,094 patients died; cause of death was known for 18,854 patients. After multivariable adjustment (demographics, comorbidities, relevant laboratory data, medication use, and kidney function), AF was associated with 23% (95% CI 18–29%) higher risk of all-cause mortality, 45% (95% CI 31–61%) higher risk of cardiovascular mortality and 13% (95% CI 3–22%) lower risk of malignancy-related mortality. Exclusion of patients with malignancy yielded similar results except for a lack of association between AF and malignancy-related deaths. Results were consistent across various stages of CKD. Conclusions: In a non-dialysis-dependent CKD population, the presence of AF was associated with higher all-cause and cardiovascular mortality. These data suggest that patients with both CKD and AF are at high cardiovascular risk, and thus clinical practice (or trials) should aim at reducing the overall excess cardiovascular mortality (not stroke alone) in patients with AF and CKD.

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Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Cited by 34 publications

References 36 publications

Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise

Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise

Sex-Specific Association of Blood Pressure Categories With All-Cause Mortality: The Rural Chinese Cohort Study

Cause-Specific Mortality in Patients with Chronic Kidney Disease and Atrial Fibrillation

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