Key result
An interleg difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg was independently associated with an increased risk of overall mortality in hemodialysis patients.
Why the study?
Does an interleg BP difference of ≥15 mmHg systolic or ≥10 mmHg diastolic predict overall and cardiovascular mortality in hemodialysis patients?
Cohort (n=210)
No
Does an interleg BP difference of ≥15 mmHg systolic or ≥10 mmHg diastolic predict overall and cardiovascular mortality in hemodialysis patients?
An interleg BP difference (systolic ≥15 mmHg or diastolic ≥10 mmHg) is a significant independent predictor of overall and cardiovascular mortality in hemodialysis patients, even after adjusting for peripheral vascular disease markers.
Answers are grounded in this paper and cite their sources.
May flag higher-risk hemodialysis patients via simple BP checks; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND AND OBJECTIVES: An interarm BP difference has been associated with atherosclerosis and adverse cardiovascular outcomes. This study investigated whether an interleg BP difference was associated with peripheral vascular disease and overall and cardiovascular mortality in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study enrolled 210 hemodialysis patients from December 2006 to January 2007. Bilateral leg BPs were measured simultaneously by an ankle-brachial index (ABI)-form device before hemodialysis. RESULTS: The mean follow-up period was 4.4±1.5 years. ABI <0.9 and high brachial-ankle pulse wave velocity were independently associated with an interleg difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg. Furthermore, this difference was an independent predictor for overall mortality (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.68-6.72; P<0.01) and cardiovascular mortality (HR, 4.84; 95% CI, 1.84-12.71; P<0.01) after adjustment for demographic, clinical, and biochemical parameters. After further adjustment for ABI <0.9 and brachial-ankle pulse wave velocity, the relation remained significant to overall mortality (HR, 2.91; 95% CI, 1.28-6.64; P=0.01) and cardiovascular mortality (HR, 3.15; 95% CI, 1.05-9.44; P=0.04). CONCLUSIONS: A difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg between legs was associated with peripheral vascular disease and increased risk for overall and cardiovascular mortality in hemodialysis patients. Detection of an interleg BP difference may identify hemodialysis patients at increased risk of peripheral vascular disease and overall and cardiovascular mortality.
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Chen et al. (2012) conducted a cohort in Hemodialysis (n=210). Interleg difference in systolic BP ≥15 mmHg or diastolic BP ≥10 mmHg vs. Interleg systolic BP difference <15 mmHg and diastolic BP difference <10 mmHg was evaluated on Overall mortality (HR 2.91, 95% CI 1.28-6.64, p=0.01). An interleg difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg was independently associated with an increased risk of overall mortality in hemodialysis patients.
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