Association between mean arterial pressure and mortality in chronic hemodialysis patients.

BACKGROUND/AIMS: Low mean arterial pressure (MAP) is associated with poor outcome in patients with cardiovascular disease; however, the prognostic role of MAP for chronic hemodialysis (HD) patients is unknown. This study was conducted to determine the association between MAP and mortality in chronic HD patients. METHODS: We prospectively analyzed all chronic HD patients between February 2001 and February 2006. The averages of blood pressure measurements from the beginning of HD treatment or February 2001 were analyzed using Kaplan-Meier analysis with log-rank tests and stepwise forward Cox regression with adjustments for age, gender, and diabetes. RESULTS: In an average of 36.3 +/- 20.2 months, 834 patients (414 men and 420 women) were analyzed and 205 (24.6%) patients died. Patients with predialytic MAP <90 mm Hg and patients with an increase of MAP >15 mm Hg during HD sessions were associated with increasing mortality in Kaplan-Meier analysis (p = 0.033 and p = 0.012). In adjusted Cox regression, predialytic MAP <90 mm Hg and MAP rose with HD was associated with an increase hazard of death (p = 0.044 and p = 0.002). CONCLUSION: We found that lower predialytic mean arterial pressure and mean arterial pressure rose with HD treatment is associated with increasing mortality in Asia HD patients. More interventional studies are needed to determine the optimal treatment for hypertensive HD patients.