Abstract: TH-PO458

Pre-ESRD Systolic Blood Pressure Trajectory and Post-ESRD Mortality

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Gosmanova, Elvira, Stratton VA Medical Center, Albany, New York, United States
  • Sim, John J., Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
  • Yamagata, Kunihiro, University of Tsukuba, Tsukuba, Japan
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Pre-ESRD systolic blood pressure (SBP) shows a reverse J-shaped association with post-ESRD mortality. However, the pre-ESRD association of SBP trajectories (decrease vs. increase vs. stable over time) with post-ESRD mortality is unknown.

Methods

We assessed SBP measurements in the last 3 years prior to dialysis in 39,383 US veterans with incident ESRD. SBP slopes and baseline levels were categorized (<-5, -5-<5, and ≥5 mmHg/year for slopes; and <130, 130-<150, and ≥150 mmHg for baseline) and combined into 9 mutually exclusive groups with slope of -5-<5 mmHg/year and baseline of 130-<150 mmHg as referent. Associations with all-cause post-ESRD mortality were examined in multivariable-adjusted Cox models.

Results

The median (interquartile interval) SBP slope and baseline SBP were -0.1 (-2.4-1.9) mmHg/year and 140 (133-149) mmHg. Decrease in SBP was associated with higher mortality, with the highest risk seen with SBP slope of <-5 mmHg/year combined with baseline SBP of <130 mmHg (adjusted hazard ratio [95% CI]: 2.02 [1.70-2.40], vs. referent; Figure). Increase in SBP was associated with lower mortality independent of baseline SBP, as was stable SBP in patients with baseline SBP ≥130 mmHg.

Conclusion

Decrease in SBP prior to dialysis start is associated with higher post-ESRD mortality, especially in patients with lower baseline SBP. Increasing SBP is associated with better outcomes independent of baseline SBP. Further studies are needed to test whether modification of pre-ESRD SBP trajectories can improve clinical outcomes in incident ESRD patients.

Funding

  • NIDDK Support