Abstract

Since less attention has been paid to the effect of passing blood pressure states on the survival of peritoneal dialysis (PD) patients, this study aimed to inves­tigate the survival of PD patients with and without hypertension, estimate the probability of hypertension and determine the influential factors. In this retro­spective cohort study, the data of 700 patients visiting dialysis centers from all provinces of Iran from 1997-2009 were analyzed. For data analysis, the multistate survival model was used. The median survival time (months) and five-year survival were 75% and 56%, respectively. Males had a higher probability of hypertension (63%) than females (52%). The risk of death in normotensive patients increased with age and fast blood sugar (FBS) (age: HR = 1.02, p-va­lue <0.001; FBS: HR = 1.03, p-value = 0.034) and decreased with increasing albumin (HR = 0.60, p-value = 0.015). When experiencing hypertension, the death risk increased with age (age: HR = 1.03, p-value<0.001); also, higher serum albumin and blood urea nitrogen (BUN) had a protective effect against mortality (albumin: HR = 0.66, p-value = 0.038; BUN: HR = 0.99, p-value = 0.014). Paying attention to age, obesity, and blood sugar in PD patients seems necessary.

References

1. Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis. Nephrol Dial Transplant. 2018; 33 (suppl_3): iii35-iii40. 2. Gupta R, Woo K, Jeniann AY, editors. Epidemiology of end-stage kidney disease. Semin Vasc Surg. 2021; 34 (1): 71-78. 3. Wetmore JB, Johansen KL. Demographics of the End-Stage Renal Disease Patient. Handbook of Dialysis Therapy. Amsterdam: Elsevier; 2023. p. 3-15. 4. Low S, Liew A, editors. Peritoneal dialysis fluids. Semin Dial; 2024: Wiley Online Library. 5. Namdar A, Naghizadeh MM, Namdar F, et al. Health-related Quality of life in Patients on Hemodialysis Compared to Peritoneal Dialysis: A cross-sec¬tional Study. JABS. 2023; 13 (3): 196-207. 6. Bello AK, Okpechi IG, Osman MA, et al. Epidemiology of peritoneal dialysis outcomes. Nat Rev Nephrol. 2022; 18 (12): 779-793. 7. Yang L, Li J, Wei W, et al. Blood Pressure Variability and the Progression of Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Gen Intern Med. 2023; 38 (5):1272-1281. 8. Tang M, Batty JA, Lin C, et al. Pulmonary hypertension, mortality, and cardiovascular disease in CKD and ESRD patients: A systematic review and meta-analysis. Am J Kidney Dis. 2018; 72 (1): 75-83. 9. Shang W, Li Y, Ren Y, et al. Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: A meta-analysis. Int Urol Nephrol. 2018; 50: 1497-1504. 10. Motedayen M, Sarokhani D, Ghiasi B, et al. Prevalence of hypertension in renal diseases in Iran: Systematic review and meta-analysis. Int J Prev Med. 2019; 10: 124. 11. Dai S, Chen Y, Shang D, et al. Association of Ambulatory Blood Pressure with All-Cause Mortality and Cardiovascular Outcomes in Peritoneal Dialysis Patients. Kidney Blood Press Res. 2020; 45 (6): 890-899. 12. Qiu Y, Ye H, Fan L, et al. Serum sodium modifies the association of systolic blood pressure with mortality in peritoneal dialysis patients. Kidney Blood Press Res. 2020; 45 (6): 916-925. 13. Tajeu GS, Booth III JN, Colantonio LD, et al. Incident cardiovascular disease among adults with blood pressure <140/90 mm Hg. Circulation. 2017; 136 (9): 798-812. 14. Mills KT, Obst KM, Shen W, et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: A system¬atic review and meta-analysis. Ann Intern Med. 2018; 168 (2): 110-120. 15. Nguyen B, Bui QTH, Tran PQ. Survival Rates in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis. Int J Nephrol Renovas Dis. 2023: 131-41. 16. Yang J, Wan J, Feng L, et al. Machine learning algorithms for the prediction of adverse prognosis in patients undergoing peritoneal dialysis. BMC Med Inform Decis Mak. 2024; 24 (1): 8. 17. Ott C, Schmieder RE. Diagnosis and treatment of arterial hypertension 2021. Kidney Int. 2022; 101 (1): 36-46. 18. Schneider MP, Hilgers KF, Schmid M, et al. Blood pressure control in chronic kidney disease: A cross-sectional analysis from the German Chronic Kidney Disease (GCKD) study. PLoS One. 2018; 13 (8): e0202604. 19. Hougaard P. Analysis of multivariate survival data. Berlin: Springer; 2000. 20. Najafi I, Alatab S, Atabak S, et al. Seventeen years’ experience of peritoneal dialysis in Iran: First official report of the Iranian peritoneal dialysis registry. Perit Dial Int. 2014; 34 (6): 636-642. 21. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; 71 (6): 1269-1324. 22. Hosseini M, Yaseri M, Asady H, et al. Prevalence of high blood pressure in Iranian adults based on the 2017 ACC/AHA guideline. Med J Islam Repub Iran. 2019; 33: 26. 23. Mohammadi S, Hassanipour S, Delam H, et al. Prevalence of hypertension in Iran: An updated systematic review and meta-analysis of community-based studies. Caspian J Intern Med. 2023; 14 (4): 607. 24. Pugh D, Gallacher PJ, Dhaun N. Management of hypertension in chronic kidney disease. Drugs. 2019; 79 (4): 365-379. 25. Yang J, Liu F, Wang B, et al. Blood pressure states transition inference based on multi-state markov model. IEEE J Biomed Health Inform. 2020; 25 (1): 237-246. 26. Wang Y, Ma Z, Xu C, et al. Prediction of transfer among multiple states of blood pressure based on Markov model: An 18-year cohort study. J hyper¬tens. 2018; 36 (7): 1506-1513. 27. Hall JE, Mouton AJ, da Silva AA, et al. Obesity, kidney dysfunction, and inflammation: Interactions in hypertension. Cardiovasc Res. 2021; 117 (8): 1859-1876. 28. Parvanova A, Reseghetti E, Abbate M, et al. Mechanisms and treatment of obesity-related hypertension—Part 1: Mechanisms. Clin Kidney J. 2024; 17 (1): sfad282. 29. Manolis AA, Manolis TA, Melita H, et al. Low serum albumin: a neglected predictor in patients with cardiovascular disease. Eur J Intern Med. 2022; 102: 24-39. 30. Bansal S. Peritoneal Membrane Dysfunction. Complications in Dialysis: A Clinical Guide. 2023: 245-52. 31. Healthcare Engineering JO. Retracted: Low Serum Albumin Is Associated with Poor Prognosis in Patients Receiving Peritoneal Dialysis Treatment. J Healthc Eng. 2023; 2023: 9891861. 32. Alves FC, Sun J, Qureshi AR, et al. The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease. PloS one. 2018; 13 (1): e0190410. 33. Kang SC, Park KS, Chang TI, et al. Sleep apnea is associated with residual kidney function and mortality in patients with peritoneal dialysis: Prospective cohort study. Semin Dial. 2022; 35 (2): 146-153. 34. Cheng S-Y, Yang L-M, Sun Z-S, et al. Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A mul¬ticenter retrospective cohort study. World J Diabetes. 2022; 13 (4): 376. 35. O’Sullivan ED, Hughes J, Ferenbach DA. Renal aging: Causes and consequences. J Am Soc Nephrol: JASN. 2017; 28 (2): 407. 36. Fang Y, Gong AY, Haller ST, et al. The ageing kidney: Molecular mechanisms and clinical implications. Ageing Res Rev. 2020; 63: 101151. 37. Afghahi H, Nasic S, Peters B, et al. Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis. PloS one. 2022; 17 (1): e0262880. 38. Ceriello A, Monnier L, Owens D. Glycaemic variability in diabetes: Clinical and therapeutic implications. Lancet Diabetes Endocrinol. 2019; 7 39. Wu N, Shen H, Liu H, et al. Acute blood glucose fluctuation enhances rat aorta endothelial cell apoptosis, oxidative stress and pro-inflammatory cytokine expression in vivo. Cardiovasc Diabetol. 2016; 15 (1): 1-13.

Included in

Epidemiology Commons

Share

COinS