Cardiovascular events (CVE) are the major cause of death in hemodialysis patients (HDP). Hypertension is present in 60-90% of HDP and it is the major risk factor for CVE. In this retrospective study we evaluated the role of hypertension on CV mortality in HDP. We recruited n. 52 patients (M/F: 35/17; age range: 41-92 years; duration of dialysis: 4-206 months). Since the censoring time started on 1982 till 2002, some patients were treated with acetate dialysis, and cuprophan membrane. HDP were divided, according to fatal events, in cardiovascular (n. 26; CVP), non cardiovascular (n. 26; NCVP). MI, sudden death, heart failure, stroke were considered as CVE. The effects of systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure both in pre- and post-dialysis on the rate of CVE were analyzed. Other factors taken into account were: age, duration of dialysis treatment, pre and post-dialysis body weight (BW), intra-dialysis BW loss, azotemia, serum uric acid and phosphorus, alkaline phosphatase, PTH, plasma cholesterol (COL) and triglycerides (TRIG), total serum proteins and albumin, hemoglobin, Ht, serum ferritin. All parameters were evaluated at 12 and 6 months and immediately before death (baseline). No difference was observed between two groups among most of parameters. However, age was higher in CVP (63.6 ± 11.6 vs 69.4 ± 53.1, respectively; P=NS), COL and TRIG were significantly (p<0.05) higher in CVP than in NCVP at each observation period. Importantly in CVP, baseline SBP, DBP and MAP in pre-dialysis were significantly lower (p<0.01) than those recorded at 6 and 12 months. Of interest no difference of blood pressure was found between CVP and NCVP at baseline, 6 and 12 months before final events. BW progressively decreased from 12 months to baseline (p<0.01) in CVP, while it increased (p<0.01) in NCVP. Hemoglobin was higher in CVP than in NCVP. In conclusion, mortality in HDP is not dependent on hypertension being baseline blood pressure similar between CVP and NCVP. Nevertheless the progressive reduction of blood pressure long before the fatal events and tha progressive decline of BW may be regarded as predictive factors for CVE. Keywords: blood pressure; haemodialysis: outcome; hypertension; blood volume Session: Poster Session: Cardiovascular risk in ESRD, cardiac hypertrophy and atherosclerosis
IS HYPERTENSION A RISK-FACTOR FOR CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS? / Musone, Dario; Esposito, Raffaela; Balletta, MARIO MARIA; Rosa, Ciro De; Russo, Domenico. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2003). (Intervento presentato al convegno World Congress of Nephrology Berlin 2003 8-12 june- tenutosi a Berlin nel 8-12 june-).
IS HYPERTENSION A RISK-FACTOR FOR CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS?
BALLETTA, MARIO MARIA;RUSSO, DOMENICO
2003
Abstract
Cardiovascular events (CVE) are the major cause of death in hemodialysis patients (HDP). Hypertension is present in 60-90% of HDP and it is the major risk factor for CVE. In this retrospective study we evaluated the role of hypertension on CV mortality in HDP. We recruited n. 52 patients (M/F: 35/17; age range: 41-92 years; duration of dialysis: 4-206 months). Since the censoring time started on 1982 till 2002, some patients were treated with acetate dialysis, and cuprophan membrane. HDP were divided, according to fatal events, in cardiovascular (n. 26; CVP), non cardiovascular (n. 26; NCVP). MI, sudden death, heart failure, stroke were considered as CVE. The effects of systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure both in pre- and post-dialysis on the rate of CVE were analyzed. Other factors taken into account were: age, duration of dialysis treatment, pre and post-dialysis body weight (BW), intra-dialysis BW loss, azotemia, serum uric acid and phosphorus, alkaline phosphatase, PTH, plasma cholesterol (COL) and triglycerides (TRIG), total serum proteins and albumin, hemoglobin, Ht, serum ferritin. All parameters were evaluated at 12 and 6 months and immediately before death (baseline). No difference was observed between two groups among most of parameters. However, age was higher in CVP (63.6 ± 11.6 vs 69.4 ± 53.1, respectively; P=NS), COL and TRIG were significantly (p<0.05) higher in CVP than in NCVP at each observation period. Importantly in CVP, baseline SBP, DBP and MAP in pre-dialysis were significantly lower (p<0.01) than those recorded at 6 and 12 months. Of interest no difference of blood pressure was found between CVP and NCVP at baseline, 6 and 12 months before final events. BW progressively decreased from 12 months to baseline (p<0.01) in CVP, while it increased (p<0.01) in NCVP. Hemoglobin was higher in CVP than in NCVP. In conclusion, mortality in HDP is not dependent on hypertension being baseline blood pressure similar between CVP and NCVP. Nevertheless the progressive reduction of blood pressure long before the fatal events and tha progressive decline of BW may be regarded as predictive factors for CVE. Keywords: blood pressure; haemodialysis: outcome; hypertension; blood volume Session: Poster Session: Cardiovascular risk in ESRD, cardiac hypertrophy and atherosclerosisI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
