LOW DIASTOLIC BLOOD-PRESSURE, HYPOALBUMINEMIA, AND RISK OF DEATH IN ACOHORT OF CHRONIC-HEMODIALYSIS PATIENTS

In a previous report, we showed that nutritional status and especially serum albumin had great predictive value for death in chronic hemodia lysis patients, whereas blood pressure did not. In the present study, we analyzed the causes of death in consideration of the relationship b etween serum albumin and blood pressure. A total of 1,243 Okinawan pat ients (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 wa s 5,110.3 patient-years. Blood pressure as well as clinical and labora tory variables were determined immediately prior to the first dialysis session in January 1991. The crude death rate was 40.0% when the dias tolic blood pressure (DBP) <70 mm Hg, 35.0% at 70 to 79 mm Hg, 25.0% a t 80 to 89 mm Hg, 25.0% at 90 to 99 mm Hg, and 13.0% at >100 mm Hg. Th e death rate showed an inverse correlation with DBP. DBP showed a sign ificant positive correlation with serum albumin (r = 0.137, P < 0.001) and age (r = -0.325, P < 0.0001). The adjusted odds ratio (95% confid ence interval) of death was 0.84 (0.71 to 0.99) with 10 mm Hg incremen ts in DBP when the reference DBP was less than 69 mm Hg. Low DBP may b e a manifestation of malnutrition and/or cardiovascular disease in chr onic hemodialysis patients. Target DBP levels may be higher levels in chronic hemodialysis patients than the general population.