Predictive Significance of Blood Pressure Values for the Incidence of Cardiovascular Events in Chronic Hemodialysis Patients

Ishimitsu, Toshihiko; Nakano, Nobuyuki; Sudo, Yasuyo; Akashiba, Akira; Takahashi, Toshiaki; Ohta, Satoshi; Minami, Junichi; Matsuoka, Hiroaki

doi:10.1291/hypres.31.1703

Cited by 14 publications

(13 citation statements)

References 26 publications

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“…SBP but not DBP was a widely accepted risk factor for LVH in HD population, 22 and time-integrated SBP was an independent predictor of increase in LMVI in HD patients. 23 These results are consistent with our present findings.…”

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confidence: 87%

BMI, spKt/V, and SBP but Not DBP Are Related to LVH in Chinese Maintenance Hemodialysis Patients

et al. 2011

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Objective: Left ventricular hypertrophy (LVH) is the strongest predictor of cardiovascular mortality, the leading cause of death in hemodialysis (HD) patients. This study aims to identify the potential risk factors for LVH in HD patients. Methods: Exactly, 164 patients (84 men and 80 women) who had been on HD treatment for at least 6 months were enrolled. Clinical data were collected. Anthropometric measurements, biochemical analyses, and echocardiography were performed. The risk factors were determined by multivariate linear and logistic regression. Results: In all the patients, the prevalence of LVH was 66.5%. The patients with LVH had higher body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure, and lower single-pool kt/V (spKt/V) compared with those without LVH.

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confidence: 87%

BMI, spKt/V, and SBP but Not DBP Are Related to LVH in Chinese Maintenance Hemodialysis Patients

et al. 2011

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“…All-cause mortality was defined by date of death if it occurred during the cohort period (July 1, 2001-June 30,2006). The recorded causes of death were obtained from the US Renal Data System, and cardiovascular death was defined as death because of myocardial infarction, cardiac arrest, heart failure, cerebrovascular accident, and other cardiac diseases.…”

Section: Outcome Measuresmentioning

confidence: 99%

Changes in Pulse Pressure during Hemodialysis Treatment and Survival in Maintenance Dialysis Patients

Lertdumrongluk

Streja²,

Rhee

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulse pressure has been shown as a risk factor for mortality in patients on maintenance hemodialysis (MHD). However, the effect of change in pulse pressure during hemodialysis on survival in a large cohort of patients on MHD has not been sufficiently investigated.Design, setting, participants, & measurements This study examined the association between time-varying D pulse pressure (postdialysis minus predialysis pulse pressure) and mortality in a cohort of 98,577 patients on MHD (July 2001-June 2006) using Cox proportional hazard models with restricted cubic splines.Results The average patient age was 62 years old; among the patients, 33% were black and 59% had diabetes. During 134,814 patient-years of at-risk time, 16,054 (16%) patients died, with 6827 (43%) of the deaths caused by cardiovascular causes. In the models including adjustment for either predialysis systolic BP or mean arterial BP, there was a U-shaped association between change in pulse pressure during hemodialysis and all-cause mortality. In the systolic BP plus case mix plus malnutrition-inflammation complex syndrome-adjusted model, large declines in pulse pressure (.-25 mmHg) and increases in pulse pressure .5 mmHg were associated with higher all-cause mortality (reference: $-5 to ,5 mmHg): hazard ratios (95% confidence intervals [95% CIs]) for change pulse pressures of ,-25, $-25 to ,-15, $-15 to ,-5, 5 to ,15, 15 to ,25, and $25 mmHg were 1.21 (95% CI, 1.14 to 1.29), 1.03 (95% CI, 0.97 to 1.10), 1.01 (95% CI, 0.96 to 1.06), 1.06 (95% CI, 1.01 to 1.11), 1.17 (95% CI, 1.11 to 1.24), and 1.15 (95% CI, 1.08 to 1.23), respectively. The U-shaped association was observed with cardiovascular death.Conclusions Modest reductions in pulse pressure after hemodialysis are associated with the greatest survival, whereas large declines or rises in pulse pressure are related to higher mortality. Trials determining how to modify pulse pressure response to improve survival in the hemodialysis population are indicated.

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“…In our prospective study following 553 chronic hemodialysis patients for 5 years, 37% patients had suffered the onset of cardiovascular events and 47% of the causes of death were cardiovascular diseases such as stroke and heart failure. 16) In addition to the traditional cardiovascular risk factors such as hypertension and diabetes, recent research has revealed that the RAAS is involved in the process of remodeling and injuries of cardiovascular tissues and organs. Components of the RAAS such as angiotensin II and aldosterone promote hypertrophy of cardiovascular cells and fibrosis of the cardiovascular tissues.…”

Section: Discussionmentioning

confidence: 99%

Effects of Efonidipine, an L- and T-type Calcium Channel Blocker, on the Renin-Angiotensin-Aldosterone System in Chronic Hemodialysis Patients

et al. 2010

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SummaryComponents of the renin-angiotensin-aldosterone system such as angiotensin II and aldosterone are believed to contribute to the development and progression of cardiovascular tissue and organ injuries. We compared the effects of two calcium channel blockers, efonidipine and amlodipine, on the renin-angiotensin-aldosterone system in patients with end-stage renal diseases on maintenance hemodialysis. Twenty hypertensive patients on chronic hemodialysis were given efonidipine 20-60 mg twice daily and amlodipine 2.5-7.5 mg once daily for 12 weeks each in a random crossover manner. The average blood pressure was comparable between the efonidipine and amlodipine periods (151 ± 15/77 ± 8 versus 153 ± 15/76 ± 8 mmHg). The pulse rate did not change significantly during the administration periods. Although the plasma renin activity and plasma angiotensin II were not significantly different between the efonidipine and amlodipine periods, plasma aldosterone was significantly lower in the efonidipine period than in the amlodipine period (123 ± 118 versus 146 ± 150 pg/mL, P = 0.027). The findings suggest that efonidipine reduces plasma aldosterone levels in patients on maintenance hemodialysis, and this seems to be an additional benefit to the cardiovascular protection by antihypertensive therapy with efonidipine in patients with end-stage renal disease. (Int Heart J 2010; 51: 188-192) Key words: Efonidipine, Hypertension, Renal failure, Hemodialysis, Aldosterone P atients with end-stage renal disease (ESRD) undergoing dialysis therapy have increased morbidity and mortality as compared with the general population. The high incidences of cardiovascular diseases and infection in particular limit the life expectancy of dialysis patients.1,2) In order to effectively prevent cardiovascular diseases in ESRD patients, not only traditional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia, but also nontraditional risk factors should be considered.3) Such nontraditional risk factors include neurohumoral factors such as activation of the sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS). Recent studies have shown that angiotensin II and aldosterone exhibit deleterious effects on the development and progression of tissue injuries in cardiovascular organs. [4][5][6] In addition, it has been shown that the circulating RAAS is not necessarily suppressed in patients on chronic hemodialysis. 7)Renal failure patients have a high prevalence of hypertension, 8-10) a major traditional cardiovascular risk factor, and calcium channel blockers (CCB) are widely used as antihypertensive drugs because of their potent hypotensive effects. CCB principally block L-type calcium channels of vascular smooth muscle, and have not been thought to directly affect RAAS. However, unlike other dihydropyridine CCB, efonidipine is known to block not only L-type but also T-type calcium channels, and recent in vitro and in vivo studies have indicated that efonidipine suppresses aldosterone secretion from the...

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Predictive Significance of Blood Pressure Values for the Incidence of Cardiovascular Events in Chronic Hemodialysis Patients

Cited by 14 publications

References 26 publications

BMI, spKt/V, and SBP but Not DBP Are Related to LVH in Chinese Maintenance Hemodialysis Patients

BMI, spKt/V, and SBP but Not DBP Are Related to LVH in Chinese Maintenance Hemodialysis Patients

Changes in Pulse Pressure during Hemodialysis Treatment and Survival in Maintenance Dialysis Patients

Effects of Efonidipine, an L- and T-type Calcium Channel Blocker, on the Renin-Angiotensin-Aldosterone System in Chronic Hemodialysis Patients

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