Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts To examine whether age, race, and diabetes status affect the association between systolic BP (SBP, predialysis) and mortality we studied a cohort of 16,283 incident hemodialysis patients We constructed a series of multivariate proportional hazards models adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality Overall low SBP associated with increased mortality and the association was more pronounced among older patients and those with diabetes Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status We observed a survival advantage for black patients primarily among older patients Diabetes associated with increased mortality mainly among older patients with low BP In conclusion the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration