Association of physical function with predialysis blood pressure in patients on hemodialysis

BMC Nephrology

Kirsten L Johansen⁵  Nancy G Kutner²  Charles A Herzog⁷  Janice Lea⁶  Patricia Painter³  David Glidden¹  Adrian P Abreo⁴ 

[1]Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

[2]United States Renal Data System Rehabilitation/Quality of Life Special Studies Center, Atlanta, USA

[3]Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA

[4]Division of Nephrology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB,G261, Cincinnati, OH 45267, USA

[5]United States Renal Data System Nutrition Special Studies Center, San Francisco, USA

[6]Division of Nephrology, Emory University, Atlanta, GA, USA

[7]United States Renal Data System, Cardiovascular Special Studies Center, Minneapolis, MN, USA

关键词: Physical function;    End-stage renal disease;    Blood pressure;   

Others  :  1082575
DOI  :  10.1186/1471-2369-15-177

 received in 2014-08-12, accepted in 2014-10-29,  发布年份 2014

【 摘 要 】

Background

New information from various clinical settings suggests that tight blood pressure control may not reduce mortality and may be associated with more side effects.

Methods

We performed cross-sectional multivariable ordered logistic regression to examine the association between predialysis blood pressure and the short physical performance battery (SPPB) in a cohort of 749 prevalent hemodialysis patients in the San Francisco and Atlanta areas recruited from July 2009 to August 2011 to study the relationship between systolic blood pressure and objective measures of physical function. Mean blood pressure for three hemodialysis sessions was analyzed in the following categories: <110 mmHg, 110-129 mmHg (reference), 130-159 mmHg, and ≥160 mmHg. SPPB includes three components: timed repeated chair stands, timed 15-ft walk, and balance tests. SPPB was categorized into ordinal groups (≤6, 7-9, 10-12) based on prior literature.

Results

Patients with blood pressure 130-159 mmHg had lower odds (OR 0.57, 95% CI 0.35-0.93) of scoring in a lower SPPB category than those whose blood pressure was between 110 and 129 mmHg, while those with blood pressure ≥160 mmHg had 0.56 times odds (95% CI 0.33-0.94) of scoring in a lower category when compared with blood pressure 110-129 mmHg. When individual components were examined, blood pressure was significantly associated with chair stand (130-159 mmHg: OR 0.59, 95% CI 0.38-0.92) and gait speed (≥160 mmHg: OR 0.59, 95% CI 0.35-0.98). Blood pressure ≥160 mmHg was not associated with substantially higher SPPB score compared with 130-159 mmHg.

Conclusions

Patients with systolic blood pressure at or above 130 mmHg had better physical performance than patients with lower blood pressure in the normotensive range. The risk-benefit tradeoff of aggressive blood pressure control, particularly in low-functioning patients, should be reexamined.

【 授权许可】

   
2014 Abreo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Group AS, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedwald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F: Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010, 362(17):1575-1585.
• [2]Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008, 358(18):1887-1898.
• [3]Goodwin JS: Embracing complexity: a consideration of hypertension in the very old. J Gerontol A Biol Sci Med Sci 2003, 58(7):653-658.
• [4]Odden MC, Peralta CA, Haan MN, Covinsky KE: Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012, 172(15):1162-1168.
• [5]James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E: 2014 evidence-based guidelines for the management of high blood pressure in adults: reports from the panel members appointed to the eight joint national committee (JNC 8). JAMA 2014, 311(5):507-520.
• [6]Rahman M, Griffin V: Patterns of antihypertensive medication use in hemodialysis patients. Am J Health Syst Pharm 2004, 61(14):1473-1478.
• [7]Roshanravan B, Robinson-Cohen C, Patel KV, Ayers E, Littman AJ, de Boer IH, Ikizler TA, Himmelfarb J, Katzel LI, Kestenbaum B, Seliger S: Association between physical performance and all-cause mortality in CKD. J Am Soc Nephrol 2013, 24(5):822-830.
• [8]McAdams-Demarco MA, Law A, Garonzik-Wang JM, Gimenez L, Jaar BG, Walston JD, Segev DL: Activity of daily living disability and dialysis mortality: better prediction using metrics of aging. J Am Geriatr Soc 2012, 60(10):1981-1982.
• [9]Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon J, Connor EB, Nevitt M, Visser M, Kritchesvsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferruci L, Guralnik J: Gait speed and survival in older adults. JAMA 2011, 305(1):50-58.
• [10]Moore GE, Brinker KR, Stray-Gunderson J, Mitchell JH: Determinants of VO2peak in patients with end-stage renal disease: on and off dialysis. Med Sci Sports Exerc 1993, 25:18-23.
• [11]Johansen KL: Exercise in the end-stage renal disease population. J Am Soc Nephrol 2007, 18:1845-1854.
• [12]U.S. Renal Data System, USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011.
• [13]Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49(2):M85-M94.
• [14]Yang CY, Yang WC, Lin YP: Postdialysis blood pressure rise predicts long-term outcomes in chronic hemodialysis patients: a four-year prospective observational cohort study. BMC Nephrol 2012, 13:12. BioMed Central Full Text
• [15]Agarwal R: Blood pressure and mortality among hemodialysis patients. Hypertension 2010, 55(3):762-768.
• [16]Port FK, Hulbert-Shearon TE, Wolfe RA, Bloembergen WE, Golper TA, Agodoa LY, Young EW: Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999, 33(3):507-517.
• [17]Robinson B, Tong L, Zhang J, Wolfe R, Goodkin D, Greenwood R, Kerr P, Morgenstern H, Li Y, Pisoni RL, Saran R, Tentori F, Akizawa T, Fukuhara S, Port FK: Blood pressure levels and mortality risk among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int 2012, 82:570-580.
• [18]Longenecker JC, Coresh J, Klag MJ, Levey AS, Martin AA, Fink NE, Powe NR: Validation of comorbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for healthy outcomes in caring for ESRD. J Am Soc Nephrol 2000, 11(3):520-529.
• [19]Kaysen GA, Larive B, Painter P, Craig A, Lindsay RM, Rocco MV, Daugirdas JT, Schulman G, Chertow GM: Baseline physical performance, health, and functioning of participants in the frequent hemodialysis network (FHN) trial. Am J Kidney Dis 2011, 57(1):101-112.
• [20]Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, Van Stone J, Levey A, Meyer KB, Klag MJ, Johnson HK, Clark E, Sadler JH, Teredesai P: “U” curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc Kidney Int 1998, 54(2):561-569.
• [21]Kooman JP, Broers NJ, Usvyat L, Thijssen S, van der Sande FM, Cornelis T, Levin NW, Leunissen KM, Kotanko P: Out of control: accelerated aging in uremia. Nephrol Dial Transplant 2013, 28(1):48-54.