Baseline blood pressure and other variables influencing survival on haemodialysis of patients without overt cardiovascular disease

Background. Age, diabetes and concomitant cardiovascular disease, recorded at the initiation of dialysis, allows the identification of patients with a high probability of eat-ly mortality. When all of these factors are taken into account the mortality rate of dialysis patients is still 3.5 times hig her than for the general population. Information on the factors that increa se the mortality of patients lacking the major cardiovascular risk factors is important because these are likely to be correctable, especially if dete cted early. Methods. We investigated prospectively the relevance of blood pressure and other variables recorded at the initiation of dialysis treatment on the sur vival of a group of 103 relatively young adult haemodialysis patients (mean age 44.3 years +/- 13 SD), with a low prevalence of comorbidity and a medi an follow-up period of 79 months. Data were analysed by the Cox proportiona l regression model and survival curves were constructed by the Kaplan-Meier method. Results. Forty-four patients died, 20 (46%) of whom as a result of cardiova scular causes. Multivariate analysis showed that mortality was associated w ith age (P = 0.0001), serum creatinine (P = 0.005, negative association), l eft ventricular (LV) mass (P = 0.003) and hypertension (P = 0.03). Mortalit y was increased by 7% for each additional year of age, by 0.7% for each 1 g increase in LV mass, and was reduced by 23% for each additional mg/dl of s erum creatinine. Hypertensive patients had a higher probability (x 2.2) of dying compared with normotensive patients. Conclusions. In addition to age and conditions of occult malnutrition, hype rtension and LV hypertrophy, when present at the initiation of dialysis, pl ay a major role in the mortality of low risk, relatively young dialysis pat ients. These potentially correctable factors should be actively sought and treated during the early stage of renal insufficiency to improve prognosis.