Association Of Blood Pressure with the Start of Renal Replacement Therapy in Elderly Compared with Young Patients Receiving Predialysis Care

BackgroundIn the growing elderly predialysis population, little is known about the effect of identified risk factors on the progression to end-stage renal disease. Therefore, we investigated the association of systolic (SBP) and diastolic blood pressure (DBP) with the start of renal replacement therapy (RRT), in elderly (>/=65 years) compared with young (<65 years) predialysis patients.MethodsIn the PREPARE-1 cohort, 547 incident predialysis patients, referred as part of the usual care to eight Dutch predialysis care outpatient clinics, were included (1999-2001) and followed until the start of dialysis, transplantation, death, or until 1 January 2008. The outcome was the start of RRT. All analyses were stratified for age; <65 years (young) and >/=65 years (elderly).ResultsIn young predialysis patients (n = 268) higher SBP (every 20 mm Hg increase) and high DBP (DBP >/=100 mm Hg compared with 80-89 mm Hg) were associated with a higher rate of starting RRT (adjusted hazard ratio (HR) (95% confidence interval) 1.21 (1.09;1.34) and 1.74 (1.16;2.62), respectively). However, in elderly predialysis patients (n = 240) only patients with SBP >/=180 mm Hg had an increased rate compared with patients with 140-159 mm Hg (adjusted HR 2.33 (1.41;3.87)). Furthermore, patients with DBP <70 or >/=100 mm Hg had an increased rate of starting RRT, independent of SBP, compared with patients with 80-89 mm Hg (fully adjusted HR 1.72 (1.01;2.94) and 2.05 (1.13;3.73), respectively).ConclusionsThe association of SBP and DBP with the start of RRT is different between elderly and young predialysis patients.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.100.