Hypertension as a determinant of survival for patients treated with home dialysis.

Background: Previous studies of the risks of hypertension for dialysis patients have yielded conflicting results. The aim of this study was to investigate, in a home dialysis population with low rates of diabetes and antihypertensive drug use, whether blood pressure (BP) was an independent risk factor for survival.

Methods: The outcome of 168 consecutive patients (94 male, 88% Caucasian), aged 48 years (SD 16), who began home hemodialysis (HD; N = 124) or home continuous ambulatory peritoneal dialysis (CAPD; N = 44) between January 1, 1985 and December 31, 1994 were analyzed retrospectively. Only 4.7% of patients took antihypertensive drugs while on dialysis. The patients were followed to December 31, 1998 with the primary outcome being all-cause mortality. Censoring events were transplantation, transfer to another center and treatment modality change. The Cox proportional hazard model was used with baseline predictors.

Results: Seventy-one patients died and the median overall survival was 4.2 years (5.6 on HD, 2.2 on CAPD, P < 0.0001). Mean BP at start of dialysis predicted survival on its own (P = 0.0009) and in the joint Cox model (P = 0.047). Other significant predictors in the joint model were age [10 year increase, relative hazard (RH) = 1.55, P = 0.0008], albumin (10 g/L decrease, RH = 2.05, P = 0.007), diabetes (RH = 3.42, P = 0.015) and peripheral vascular disease (RH = 2.19, P = 0.02) but not dialysis modality (RH = 1.63, P = 0.13). High and low mean blood pressure (BP) values at the start of dialysis were associated with the highest mortality.

Conclusions: Among the home dialysis patients, most of whom did not require antihypertensive drugs, hypertension was a risk factor for survival and patients with mid-range BP values survived the longest.