ABSTRACT
In a previous report, we showed that nutritional status and especially serum albumin had great predictive value for death in chronic hemodialysis patients, whereas blood pressure did not. In the present study, we analyzed the causes of death in consideration of the relationship between serum albumin and blood pressure. A total of 1,243 Okinawan patients (719 males, 524 females) undergoing hemodialysis in January 1991 were followed up through the end of 1995. Three hundred forty-two of the patients died, 45 received transplants, and 12 were transferred by the end of the follow-up period. The total duration of observation was 5,110.3 patient-years. Blood pressure as well as clinical and laboratory variables were determined immediately prior to the first dialysis session in January 1991. The crude death rate was 40.0% when the diastolic blood pressure (DBP) <70 mm Hg, 35.0% at 70 to 79 mm Hg, 25.0% at 80 to 89 mm Hg, 25.0% at 90 to 99 mm Hg, and 13.0% at >100 mm Hg. The death rate showed an inverse correlation with DBP. DBP showed a significant positive correlation with serum albumin (r = 0.137, P < 0.001) and age (r = -0.325, P < 0.0001). The adjusted odds ratio (95% confidence interval) of death was 0.84 (0.71 to 0.99) with 10 mm Hg increments in DBP when the reference DBP was less than 69 mm Hg. Low DBP may be a manifestation of malnutrition and/or cardiovascular disease in chronic hemodialysis patients. Target DBP levels may be higher levels in chronic hemodialysis patients than the general population.
Subject(s)
Blood Pressure , Hypotension/etiology , Renal Dialysis/adverse effects , Renal Dialysis/mortality , Serum Albumin/deficiency , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Cause of Death , Cohort Studies , Diastole , Female , Hemodynamics , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Hypotension/physiopathology , Japan/epidemiology , Male , Middle Aged , Nutrition Disorders/blood , Nutrition Disorders/etiology , Nutrition Disorders/physiopathology , Prospective Studies , Risk Factors , Survival AnalysisABSTRACT
We analyzed 566 patients (515 females and 51 males) with systemic lupus erythematosus who were treated in Okinawa, Japan, from 1972 to 1991 and followed until April 1993. One hundred four patients (95 females and 9 males) died, and 51 were considered to have end-stage lupus nephritis. The annual incidence and prevalence, per million population in each sex, were increased from 16.0 and 66.0 in 1972 to 46.7 and 683.9 in 1991 in the female patients, and from 4.2 and 8.3 in 1973 to 8.3 and 70.0 in 1991 in the male patients, respectively. Cox proportional hazard analysis was done to determine the effects of several covariates on patients and renal survival. The patients' survival rate improved, as the hazard ratio (HR) was decreased to 0.69 (year of diagnosis, 1982 to 1986) and to 0.48 (year of diagnosis, 1987 to 1991) when the HR in patients diagnosed before 1981 was taken as 1.00. Similarly, we examined renal survival by using the Cox proportional model. For this analysis, the date of start of dialysis therapy was regarded as the time of renal death. Male patients had significantly poor renal survival; the HR was 3.64 (95% confidence interval, 1.89 to 6.98) when the HR in the females was taken as 1.00. However, age at diagnosis and year of diagnosis did not significantly affect renal survival. The cumulated incidence of end-stage lupus nephritis from the time of diagnosis of systemic lupus erythematosus was 3.1% at 5 years, 9.4% at 10 years, 15.5% at 15 years, and 21.0% at 20 years.(ABSTRACT TRUNCATED AT 250 WORDS)
