Blood Pressure and Mortality Risk In Patients Treated by Peritoneal Dialysis

摘要

It has become increasingly clear that traditional cardiovascular risk factors, including blood pressure, must be interpreted in the context of age and comorbid conditions. Therefore, studies conducted in the general population may not be applicable to specific medical subpopulations. This is especially true for dialysis patients,1 in whom several factors exist that may complicate the identification of an ideal blood pressure target. These factors include blood pressure variability due to ultrafiltration and changes in fluid intake, as well as the presence of functioning or failed vascular accesses in the arms, which may make standardized blood pressure ascertainment challenging. Perhaps most importantly, in contrast to the general population, no adequately powered randomized clinical trials examining hard outcomes have been conducted among he-modialysis patients to determine appropriate blood pressure targets.2'3 Counter to findings from general population studies, results from several observational studies conducted using administrative data sets from large dialysis organizations suggest that mild to moderate hypertension may be well tolerated during the first few years after initiation of hemodialysis. In contrast, among kidney transplant recipients, hypertension is an established risk factor for mortality#