Preexisting Cardiovascular Disease, Hypertension, and Mortality in Peritoneal Dialysis

TL;DR

This study finds that having preexisting heart disease and high blood pressure worsens survival in patients starting peritoneal dialysis.

Contribution

The study is the first to comprehensively evaluate the combined impact of preexisting cardiovascular disease and hypertension on mortality in peritoneal dialysis patients.

Findings

Patients with both preexisting CVD and hypertension had the highest risk of all-cause and CVD mortality.

Preexisting CVD was more strongly associated with mortality than hypertension alone.

The joint effects of CVD and hypertension showed additive risks without significant interaction.

Abstract

Preexisting cardiovascular disease (CVD) and hypertension
are each associated with poor prognosis in peritoneal dialysis (PD) patients.
Joint associations of preexisting CVD and hypertension have not been
comprehensively evaluated in this population.

We conducted a
retrospective cohort study of 3073 Chinese incident PD patients from five
dialysis centres between January 1, 2005, and December 31, 2018. The joint
associations between preexisting CVD, hypertension, and mortality were analysed
using Cox regression models.

Over a median of 33.7 months of
follow-up, 581 (18.6%) patients died, with 286 (9.3%) deaths due to CVD. After
adjusting for confounding factors, the preexisting CVD coexisting with
hypertension, preexisting CVD, and hypertension groups had higher risks of
all-cause mortality (hazard ratio [HR]: 3.97, 95% confidence interval [CI]: 3.06
to 5.15; HR: 2.21, 95% CI: 1.29 to 3.79; and HR: 1.83, 95% CI: 1.47 to 2.29,
respectively) and CVD mortality (HR: 4.68, 95% CI: 3.27 to 6.69; HR: 2.10, 95%
CI: 0.95 to 4.62; and HR: 1.86, 95% CI: 1.36 to 2.54, respectively) than the
control group without preexisting CVD or hypertension (p for trend
<0.001). There was no interaction between subgroup analyses (p >
0.05). The joint associations showed similar patterns using the Fine–Gray
competing risk models.

Preexisting CVD and hypertension at
the start of PD were additive prognostic utilities for mortality, and preexisting
CVD was more strongly associated with mortality than hypertension.

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