1. One-Size-Fits-All Blood Pressure Recommendations Won’t Suit All Dialysis Patients Age, Race, and Diabetes Status Affect Blood Pressure’s Link to Premature Death.
Previous research indicates that mild to moderate hypertension may not increase dialysis patients’ risk of dying prematurely. These findings contrast with those found in the general population and are generalized to diverse groups of patients with kidney disease.
To see if age, race, and the presence or absence of diabetes affects the relationship between blood pressure and risk of premature death among dialysis patients, Philip Zager, MD, Orrin Myers, PhD (University of New Mexico), and their colleagues studied medical information from 16,283 dialysis patients.
The researchers found that (1) low systolic blood pressure was associated with increased risk of premature death, particularly among older patients and patients with diabetes; (2) higher systolic blood pressure was associated with increased risk of premature death among younger patients, regardless of race or diabetes status; (3) older black patients had a survival advantage over older patients of other races; and (4) diabetes was associated with increased risk of premature death mainly among older patients with low blood pressure.
These findings indicate that identifying optimal blood pressure ranges for dialysis patients with kidney disease should take age and diabetes status into consideration.
In an accompanying editorial, Deidra Crews, MD, ScM (Johns Hopkins University) and Neil Powe, MD, MPH, MBA (University of California San Francisco and San Francisco General Hospital) noted that “this is certainly one of the best observational studies to pay attention to how outcomes are different in certain patient groups.
” They added that the results raise a number of questions for clinicians as they address blood pressure in dialysis patients. “Let’s hope that soon we will generate the evidence needed to guide the often complicated blood pressure management of our patients,” they wrote.
Source: Shari Leventhal
American Society of Nephrology