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Association of body mass index and uncontrolled blood pressure with cardiovascular mortality in peritoneal dialysis patients

Journal of Human Hypertension volume 33, pages 106–114 (2019)Cite this article

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Abstract

The association of body mass index (BMI) and blood pressure (BP) control and their interaction with cardiovascular (CV) mortality in continuous ambulatory peritoneal dialysis (CAPD) patients is unclear. We retrospectively analyzed a consecutive series of 1595 incident CAPD patients with hypertension from 2006 to 2013, and followed up through December 2015. The BMI was categorized according to the World Health Organization classification for Asian population. Binary logistic regression was used to assess the relationship between BMI and BP control. Cox’s proportional hazards models and competing risk analyses were performed to examine the nassociation of BMI and BP control with CV mortality. In the entire cohort, obesity was unlikely related to increased risk of uncontrolled BP. However, the adjusted hazard ratio (AHR) of CV mortality was increased in individuals with obesity when compared to those with normal weight (AHR 1.56; 95% confidence interval (CI) 1.04–2.34) and in individuals with uncontrolled BP when compared to those with controlled BP (AHR 1.39; (1.02–1.89)). Subgroup analyses showed that the combination of obesity and uncontrolled BP was associated with an increased risk for CV death, when compared to normal weight subjects with uncontrolled BP (AHR 2.35; (1.43–3.86)). Further, subjects with obesity and uncontrolled BP had a nearly threefold increase in risk (AHR 2.57; (1.57–4.20)) for CV death compared to subjects with neither risk factor. These associations persisted in competing risk analyses. In conclusion, the association of obesity with CV mortality was likely to vary with hypertension status among CAPD patients.

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References

  1. Lynn KL, McGregor DO, Moesbergen T, Buttimore AL, Inkster JA, Wells JE. Hypertension as a determinant of survival for patients treated with home dialysis. Kidney Int. 2002;62:2281–7.

    Article  Google Scholar 

  2. Salem MM. Hypertension in the hemodialysis population: a survey of 649 patients. Am J Kidney Dis. 1995;26:461–8.

    Article  CAS  Google Scholar 

  3. Prospective Studies C. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.

    Article  Google Scholar 

  4. Zhang CX, Shi JD, Huang HY, Feng LM, Ma J. Nutritional status and its relationship with blood pressure among children and adolescents in South China. Eur J Pediatr. 2012;171:1073–9.

    Article  CAS  Google Scholar 

  5. Agarwal R. Body mass index-mortality paradox in hemodialysis: can it be explained by blood pressure? Hypertension. 2011;58:1014–20.

    Article  CAS  Google Scholar 

  6. Vashistha T, Mehrotra R, Park J, Streja E, Dukkipati R, Nissenson AR, et al. Effect of age and dialysis vintage on obesity paradox in long-term hemodialysis patients. Am J Kidney Dis. 2014;63:612–22.

    Article  Google Scholar 

  7. Badve SV, Hawley CM, McDonald SP, Mudge DW, Rosman JB, Brown FG, et al. Automated and continuous ambulatory peritoneal dialysis have similar outcomes. Kidney Int. 2008;73:480–8.

    Article  CAS  Google Scholar 

  8. McDonald SP, Collins JF, Johnson DW. Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J Am Soc Nephrol. 2003;14:2894–901.

    Article  Google Scholar 

  9. Kiran VR, Zhu TY, Yip T, Lui SL, Lo WK. Body mass index and mortality risk in Asian peritoneal dialysis patients in Hong Kong-impact of diabetes and cardiovascular disease status. Perit Dial Int. 2014;34:390–8.

    Article  CAS  Google Scholar 

  10. Kim YK, Kim SH, Kim HW, Kim YO, Jin DC, Song HC, et al. The association between body mass index and mortality on peritoneal dialysis: a prospective cohort study. Perit Dial Int. 2014;34:383–9.

    Article  CAS  Google Scholar 

  11. Prasad N, Sinha A, Gupta A, Sharma RK, Bhadauria D, Chandra A, et al. Effect of body mass index on outcomes of peritoneal dialysis patients in India. Perit Dial Int. 2014;34:399–408.

    Article  Google Scholar 

  12. Pliakogiannis T, Trpeski L, Taskapan H, Shah H, Ahmad M, Fenton S, et al. Reverse epidemiology in peritoneal dialysis patients: the Canadian experience and review of the literature. Int Urol Nephrol. 2007;39:281–8.

    Article  CAS  Google Scholar 

  13. Mehrotra R, Chiu YW, Kalantar-Zadeh K, Vonesh E. The outcomes of continuous ambulatory and automated peritoneal dialysis are similar. Kidney Int. 2009;76:97–107.

    Article  Google Scholar 

  14. Ahmadi SF, Zahmatkesh G, Streja E, Mehrotra R, Rhee CM, Kovesdy CP, et al. Association of body mass index with mortality in peritoneal dialysis patients: a systematic review and meta-analysis. Perit Dial Int. 2016;36:315–25.

    Article  Google Scholar 

  15. Ramkumar N, Pappas LM, Beddhu S. Effect of body size and body composition on survival in peritoneal dialysis patients. Perit Dial Int. 2005;25:461–9.

    PubMed  Google Scholar 

  16. Liu J, Zeng X, Hong HG, Li Y, Fu P. The association between body mass index and mortality among Asian peritoneal dialysis patients: a meta-analysis. PLoS ONE. 2017;12:e0172369.

    Article  Google Scholar 

  17. Zhang X, Yu D, Cai Y, Shang J, Qin R, Xiao J, et al. Dose–response between cardiovascular risk factors and cardiovascular mortality among incident peritoneal dialysis patients. Kidney Blood Press Res. 2018;43:628–38.

    Article  CAS  Google Scholar 

  18. Weber MA, Jamerson K, Bakris GL, Weir MR, Zappe D, Zhang Y, et al. Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. Lancet. 2013;381:537–45.

    Article  Google Scholar 

  19. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383:1899–911.

    Article  Google Scholar 

  20. Wang AY, Brimble KS, Brunier G, Holt SG, Jha V, Johnson DW, et al. ISPD cardiovascular and metabolic guidelines in adult peritoneal dialysis patients part I—assessment and management of various cardiovascular risk factors. Perit Dial Int. 2015;35:379–87.

    Article  Google Scholar 

  21. Investigators ET, Chertow GM, Block GA, Correa-Rotter R, Drueke TB, Floege J, et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367:2482–94.

    Article  Google Scholar 

  22. Noordzij M, Leffondre K, van Stralen KJ, Zoccali C, Dekker FW, Jager KJ. When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant. 2013;28:2670–7.

    Article  Google Scholar 

  23. Sonne-Holm S, Sorensen TI, Jensen G, Schnohr P. Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. BMJ. 1989;299:767–70.

    Article  CAS  Google Scholar 

  24. Thompson D, Edelsberg J, Colditz GA, Bird AP, Oster G. Lifetime health and economic consequences of obesity. Arch Intern Med. 1999;159:2177–83.

    Article  CAS  Google Scholar 

  25. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med. 2003;115:291–7.

    Article  Google Scholar 

  26. Salahudeen AK. Underweight rather than overweight is associated with higher prevalence of hypertension: BP vs BMI in haemodialysis population. Nephrol Dial Transplant. 2004;19:427–32.

    Article  Google Scholar 

  27. Abbott KC, Glanton CW, Trespalacios FC, Oliver DK, Ortiz MI, Agodoa LY, et al. Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int. 2004;65:597–605.

    Article  Google Scholar 

  28. Stack AG, Murthy BV, Molony DA. Survival differences between peritoneal dialysis and hemodialysis among “large” ESRD patients in the United States. Kidney Int. 2004;65:2398–408.

    Article  Google Scholar 

  29. Xiong L, Cao S, Xu F, Zhou Q, Fan L, Xu Q, et al. Association of body mass index and body mass index change with mortality in incident peritoneal dialysis patients. Nutrients. 2015;7:8444–55.

    Article  CAS  Google Scholar 

  30. Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment—a position paper of the The Obesity Society and The American Society of Hypertension. Obesity (Silver Spring). 2013;21:8–24.

    Article  Google Scholar 

  31. Kalantar-Zadeh K, Kilpatrick RD, Kuwae N, Wu DY. Reverse epidemiology: a spurious hypothesis or a hardcore reality? Blood Purif. 2005;23:57–63.

    Article  Google Scholar 

  32. Fernandes NM, Bastos MG, Franco MR, Chaoubah A, Lima Mda G, Divino-Filho JC, et al. Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study. Clinics (Sao Paulo). 2013;68:51–8.

    Article  Google Scholar 

  33. Drawz PE, Abdalla M, Rahman M. Blood pressure measurement: clinic, home, ambulatory, and beyond. Am J Kidney Dis. 2012;60:449–62.

    Article  Google Scholar 

  34. O’Shaughnessy MM, Durcan M, Kinsella SM, Griffin MD, Reddan DN, Lappin DW. Blood pressure measurement in peritoneal dialysis: which method is best? Perit Dial Int. 2013;33:544–51.

    Article  Google Scholar 

  35. Koc M, Toprak A, Tezcan H, Bihorac A, Akoglu E, Ozener IC. Uncontrolled hypertension due to volume overload contributes to higher left ventricular mass index in CAPD patients. Nephrol Dial Transplant. 2002;17:1661–6.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported grants from the National Natural Science Foundation of China (81670630, 81270783), National Key R&D Program, China (No. 2016YFC0906100), and the Guangzhou Committee of Science and Technology, China (No. 2017B030314019).

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  1. These authors contributed equally: Wei Li, Ricong Xu

Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Wei Li, Ricong Xu, Yating Wang, Jiani Shen, Zhijian Li, Xueqing Yu & Haiping Mao

  2. Key Laboratory of Nephrology, Ministry of Health of China, Guangzhou, China

    Wei Li, Ricong Xu, Yating Wang, Jiani Shen, Zhijian Li, Xueqing Yu & Haiping Mao

  3. Department of Nephrology, First People’s Hospital of Foshan, Foshan, China

    Wei Li

  4. Department of Nephrology, Shenzhen Second People’s Hospital and the First Affiliated Hospital of Shenzhen University, Shenzhen, China

    Ricong Xu

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  1. Wei Li
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Correspondence to Haiping Mao.

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Li, W., Xu, R., Wang, Y. et al. Association of body mass index and uncontrolled blood pressure with cardiovascular mortality in peritoneal dialysis patients. J Hum Hypertens 33, 106–114 (2019). https://doi.org/10.1038/s41371-018-0107-5

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