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Abstract: PO1272

Association of Ambulatory Blood Pressure with All-Cause Mortality and Cardiovascular Outcomes in Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Dai, Shuqi, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Chen, Yun, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Shang, Da, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Hao, Chuan-Ming, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Zhu, Tongying, Huashan Hospital Fudan University, Shanghai, Shanghai, China
Background

Ambulatory blood pressure monitoring (ABPM) is the gold standard for the diagnosis of hypertension, but its effects on all-cause mortality and cardiovascular outcomes in peritoneal dialysis (PD) patients remain uncertain. We aimed to investigate the association of ambulatory blood pressure and clinical outcomes in PD patients and to explain the underlying cause of the association.

Methods

A prospective, observational cohort study was conducted in PD patients enrolled from March 2001 to July 2018 and followed until October 2019. Blood pressure was evaluated using 24-hour ambulatory blood pressure monitoring. The endpoints included all-cause mortality, cardiovascular mortality and cardiovascular events. Multivariable Cox regression was used to identify the associations between ambulatory blood pressure and endpoints. Subsequently, multivariable logistic regression was conducted to identify factors associated with elevated pulse pressure.

Results

A total of 260 PD patients (154men, 59.2%) were recruited. The median follow-up duration was 40.7 months. Our studies revealed that pulse pressure was an independent predictor for all-cause mortality (HR, 1.018; 95%CI, 1.001-1.034; P=0.032), cardiovascular mortality (HR, 1.039; 95%CI, 1.017-1.061; P<0.001) and cardiovascular events (HR, 1.028; 95%CI, 1.011-1.046; P=0.001). Systolic blood pressure was an independent predictor of cardiovascular mortality (HR, 1.023; 95%CI, 1.007-1.040; P=0.005) and cardiovascular events (HR, 1.018; 95%CI, 1.006-1.030; P=0.003). The presence of vascular calcification (OR, 3.069; 95%CI, 1.632-5.772; P=0.001) and NT-proBNP (OR, 1.074; 95%CI, 1.026-1.124; P=0.002) were significantly associated with elevated pulse pressure.

Conclusion

24-hour ambulatory pulse pressure is the most significant predictor of all blood pressure indicators for clinical outcomes in PD patients, and systolic blood pressure is an independent predictor for cardiovascular outcomes. Meanwhile, it suggests that the associations can be explained by vascular calcification and volume status in PD patients.

Funding

  • Other NIH Support