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Postdialysis blood pressure is a better predictor of mortality than predialysis blood pressure in Japanese hemodialysis patients: the Japan Dialysis Outcomes and Practice Patterns Study

Hypertension Research volume 43, pages 791–797 (2020)Cite this article

A Comment to this article was published on 02 April 2020

Abstract

Blood pressure (BP) is reportedly a predictor of mortality in hemodialysis (HD) patients; however, it is unclear whether pre- or postdialysis BP has greater predictive power. To evaluate the association of pre- and postdialysis BP with patient survival in Japanese HD patients, we enrolled the entire phase 3 and 4 Japan Dialysis Outcomes and Practice Patterns Study populations. Among 3176 patients, 486 were excluded because of missing data. The remaining 2690 patients were divided into five groups according to pre- or postdialysis systolic BP (SBP): <100, 100–119, 120–139, 140–159, and ≥160 mmHg; diastolic BP (DBP): <60, 60–79, 80–89, 90–99, and ≥100 mmHg; or pulse pressure (PP): <50, 50–59, 60–69, 70–79, and ≥80 mmHg. The hazard ratios for all-cause and cardiovascular mortalities were estimated according to pre- and postdialysis SBP, DBP, and PP using a Cox proportional hazards model. During the follow-up period, 495 and 193 subjects died because of any cause and cardiovascular disease (CVD), respectively. In the multivariable-adjusted Cox proportional hazards model, U-shaped associations of postdialysis SBP and PP with mortality rates were observed, but no significant associations were observed with predialysis SBP or PP. A stratified analysis showed significant interactions between history of CVD and postdialysis SBP with all-cause and cardiovascular mortality. Compared with predialysis values, postdialysis SBP and PP are better predictors of all-cause and cardiovascular mortality, showing U-shaped associations with these outcomes in Japanese HD patients.

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Acknowledgements

We would like to thank the Arbor Research Collaborative for Health, Ann Arbor, MI, USA, for administering the J-DOPPS and express our appreciation for the support of Kyowa Hakko Kirin, without restrictions on publication. The DOPPS.org website lists the full details. We also thank the study nurses, physicians, and medical directors for all the time and attention that they devoted to our study.

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Authors and Affiliations

  1. Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan

    Kazuhiko Tsuruya

  2. Department of Medical Science, Kawasaki Medical School, Kurashiki, Okayama, Japan

    Eiichiro Kanda

  3. Medical Affairs, Kyowa Kirin Co., Ltd., Tokyo, Japan

    Takanobu Nomura

  4. Clinical Research Support Center, Nakamura Clinic, Urasoe, Okinawa, Japan

    Kunitoshi Iseki

  5. Fukuoka Renal Clinic, Fukuoka, Japan

    Hideki Hirakata

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  1. Kazuhiko Tsuruya
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  2. Eiichiro Kanda
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  3. Takanobu Nomura
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  4. Kunitoshi Iseki
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Correspondence to Kazuhiko Tsuruya.

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Conflict of interest

KT has received speaker’s fees, consultant fees, and a research grant from Kyowa Kirin. EK has been a member of a biostatistics support group for the J-DOPPS program, which is supported by Kyowa Kirin. TN is a current employee of Kyowa Kirin. KI has received speaker’s fee from Kyowa Kirin. HH has received speaker’s fees from Kyowa Kirin.

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Tsuruya, K., Kanda, E., Nomura, T. et al. Postdialysis blood pressure is a better predictor of mortality than predialysis blood pressure in Japanese hemodialysis patients: the Japan Dialysis Outcomes and Practice Patterns Study. Hypertens Res 43, 791–797 (2020). https://doi.org/10.1038/s41440-020-0425-1

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