Christopher C Mayer1,2, Julia Matschkal3, Pantelis A Sarafidis4, Stefan Hagmair5,2, Georg Lorenz3, Susanne Angermann3, Matthias C Braunisch3, Marcus Baumann6, Uwe Heemann3, Siegfried Wassertheurer5,2, Christoph Schmaderer7. 1. Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria; christopher.mayer@ait.ac.at christoph.schmaderer@mri.tum.de. 2. Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria. 3. Department of Nephrology, Technical University of Munich, Klinkum rechts der Isar, Munich, Germany. 4. Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece; and. 5. Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria. 6. Internistische Fachklinik Dr. Steger, Nuremberg, Germany. 7. Department of Nephrology, Technical University of Munich, Klinkum rechts der Isar, Munich, Germany; christopher.mayer@ait.ac.at christoph.schmaderer@mri.tum.de.
Abstract
BACKGROUND: Evidence on the utility of ambulatory BP monitoring for risk prediction has been scarce and inconclusive in patients on hemodialysis. In addition, in cardiac diseases such as heart failure and atrial fibrillation (common among patients on hemodialysis), studies have found that parameters such as systolic BP (SBP) and pulse pressure (PP) have inverse or nonlinear (U-shaped) associations with mortality. METHODS: In total, 344 patients on hemodialysis (105 with atrial fibrillation, heart failure, or both) underwent ambulatory BP monitoring for 24 hours, starting before a dialysis session. The primary end point was all-cause mortality; the prespecified secondary end point was cardiovascular mortality. We performed linear and nonlinear Cox regression analyses for risk prediction to determine the associations between BP and study end points. RESULTS: During the mean 37.6-month follow-up, 115 patients died (47 from a cardiovascular cause). SBP and PP showed a U-shaped association with all-cause and cardiovascular mortality in the cohort. In linear subgroup analysis, SBP and PP were independent risk predictors and showed a significant inverse relationship to all-cause and cardiovascular mortality in patients with atrial fibrillation or heart failure. In patients without these conditions, these associations were in the opposite direction. SBP and PP were significant independent risk predictors for cardiovascular mortality; PP was a significant independent risk predictor for all-cause mortality. CONCLUSIONS: This study provides evidence for the U-shaped association between peripheral ambulatory SBP or PP and mortality in patients on hemodialysis. Furthermore, it suggests that underlying cardiac disease can explain the opposite direction of associations.
BACKGROUND: Evidence on the utility of ambulatory BP monitoring for risk prediction has been scarce and inconclusive in patients on hemodialysis. In addition, in cardiac diseases such as heart failure and atrial fibrillation (common among patients on hemodialysis), studies have found that parameters such as systolic BP (SBP) and pulse pressure (PP) have inverse or nonlinear (U-shaped) associations with mortality. METHODS: In total, 344 patients on hemodialysis (105 with atrial fibrillation, heart failure, or both) underwent ambulatory BP monitoring for 24 hours, starting before a dialysis session. The primary end point was all-cause mortality; the prespecified secondary end point was cardiovascular mortality. We performed linear and nonlinear Cox regression analyses for risk prediction to determine the associations between BP and study end points. RESULTS: During the mean 37.6-month follow-up, 115 patients died (47 from a cardiovascular cause). SBP and PP showed a U-shaped association with all-cause and cardiovascular mortality in the cohort. In linear subgroup analysis, SBP and PP were independent risk predictors and showed a significant inverse relationship to all-cause and cardiovascular mortality in patients with atrial fibrillation or heart failure. In patients without these conditions, these associations were in the opposite direction. SBP and PP were significant independent risk predictors for cardiovascular mortality; PP was a significant independent risk predictor for all-cause mortality. CONCLUSIONS: This study provides evidence for the U-shaped association between peripheral ambulatory SBP or PP and mortality in patients on hemodialysis. Furthermore, it suggests that underlying cardiac disease can explain the opposite direction of associations.
Authors: Adriaan A Voors; Colin J Petrie; Mark C Petrie; Andrew Charlesworth; Hans L Hillege; Felix Zijlstra; John J McMurray; Dirk J van Veldhuisen Journal: Eur Heart J Date: 2005-04-15 Impact factor: 29.983
Authors: Christoph Schmaderer; Susanne Tholen; Anna-Lena Hasenau; Christine Hauser; Yana Suttmann; Siegfried Wassertheurer; Christopher C Mayer; Axel Bauer; Kostantinos D Rizas; Stephan Kemmner; Konstantin Kotliar; Bernhard Haller; Johannes Mann; Lutz Renders; Uwe Heemann; Marcus Baumann Journal: BMC Nephrol Date: 2016-10-26 Impact factor: 2.388
Authors: Kirsten S Dorans; Hua He; Jing Chen; Mirela Dobre; Alan S Go; L Lee Hamm; Bernard G Jaar; Rupal C Mehta; Mahboob Rahman; Ana C Ricardo; Sylvia E Rosas; Anand Srivastava; Jiang He Journal: Nephrol Dial Transplant Date: 2021-12-02 Impact factor: 5.992