Preexisting Cardiovascular Disease, Hypertension, and Mortality in Peritoneal Dialysis.

ABSTRACT

Background: Preexisting cardiovascular disease (CVD) and hypertension are each associated with poor prognosis in peritoneal dialysis (PD) patients. Joint associations of preexisting CVD and hypertension have not been comprehensively evaluated in this population. Methods: We conducted a retrospective cohort study of 3073 Chinese incident PD patients from five dialysis centres between January 1, 2005, and December 31, 2018. The joint associations between preexisting CVD, hypertension, and mortality were analysed using Cox regression models. Results: Over a median of 33.7 months of follow-up, 581 (18.6%) patients died, with 286 (9.3%) deaths due to CVD. After adjusting for confounding factors, the preexisting CVD coexisting with hypertension, preexisting CVD, and hypertension groups had higher risks of all-cause mortality (hazard ratio [HR] 3.97, 95% confidence interval [CI] 3.06 to 5.15; HR 2.21, 95% CI 1.29 to 3.79; and HR 1.83, 95% CI 1.47 to 2.29, respectively) and CVD mortality (HR 4.68, 95% CI 3.27 to 6.69; HR 2.10, 95% CI 0.95 to 4.62; and HR 1.86, 95% CI 1.36 to 2.54, respectively) than the control group without preexisting CVD or hypertension (p for trend < 0.001). There was no interaction between subgroup analyses (p > 0.05). The joint associations showed similar patterns using the Fine-Gray competing risk models. Conclusions: Preexisting CVD and hypertension at the start of PD were additive prognostic utilities for mortality, and preexisting CVD was more strongly associated with mortality than hypertension.