대한신장학회

논문분류	춘계학술대회 초록집
제목	Association between Blood Pressure Levels and Adverse Clinical Outcomes in Korean Patients Undergoing Hemodialysis
저자	Fa Mee Doh1, Mi Jung Lee1, Hyang Mo Koo1, Chan Ho Kim1, Hyung Jung Oh1,Jung Tak Park1, Seung Hyeok Han1, Tae-Hyun Yoo1, Yong-Lim Kim2,
출판정보	2013; 2013(1):
키워드	혈압, 혈액투석, 불량한 예후/ Blood pressure, Hemodialysis, Adverse outcome
초록	Background: Hypertension is a well-known independent predictor of the clinical outcome in patients with end-stage renal disease (ESRD). In ESRD patients on hemodialysis (HD), therefore, blood pressure (BP) control is a very crucial issue and most current guidelines recommend that target pre- and post-dialysis blood pressure (BP) should be <140/ 90 mmHg and <130/80 mmHg, respectively. However, some previous studies failed to demonstrate a favorable prognostic power of this target of BP in these patients. Method: A prospective cohort of 807 incident HD patients from 36 dialysis centers of the Clinical Research Center for ESRD in Korea was selected, and the impact of BP levels on a composite of all-cause mortality and cardiovascular events (primary outcome) was clarified. Time-averaged pre- and post-dialysis systolic BP (SBP) and diastolic BP (DBP) were determined as means of each BP measured at 6-month intervals. Results: The mean time-average BPs were as follows: pre-dialysis SBP, 146±19 mmHg; pre-dialysis DBP, 77±12 mmHg; post-dialysis SBP, 143±18 mmHg; and post-dialysis DBP, 77±12 mmHg. During a mean follow-up duration of 19.0 months, 65 patients died and 49 CV events occurred. Compared to patients with pre-dialysis SBP of 140-149 mmHg, hazard ratios (HRs) for the primary outcome were 2.16 [95% confidence interval (CI), 1.02-4.56; p=0.044], 1.90 (95% CI, 0.94-3.84; p=0.073), 2.28 (95% CI, 1.13-4.60; p=0.021), and 2.42 (95% CI, 1.23-4.76; p=0.010) in the pre-dialysis SBP groups of <130, 130-139, 150-159, and ≥160 mmHg after adjustment for potential confounders. Similar relationship was also observed across post-dialysis SBP categories, where post-dialysis SBP ≥150 mmHg was associated with an increased risk of the composite outcome. In terms of DBP, HRs for the primary outcome in the pre-dialysis DBP groups of <60, 60-69, 80-89, and ≥90 mmHg were 0.56 (95% CI, 0.25-1.29; p=0.171), 0.50 (95% CI, 0.29-0.85; p=0.011), 0.87 (95% CI, 0.51-1.48; p=0.596), and 2.55 (95% CI, 1.13-5.71; p=0.024), respectively, when compared to patients with pre-dialysis DBP of 70-79 mmHg. Similarly, post-dialysis DBP ≥90 mmHg exhibited the higher risk for the composite outcome. Conclusions: Pre-dialysis SBP of 140-149 mmHg and post-dialysis SBP of 130-149 mmHg are revealed to be the optimal BP levels associated with a favorable clinical outcome in incident HD patients. In addition, maintaining pre- and postdialysis DBP <90 mmHg may provide a more beneficial effect in these patients.
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