Dose-Response Between Cardiovascular Risk Factors and Cardiovascular Mortality Among Incident Peritoneal Dialysis...

Traditional cardiovascular (CV) risk factors (RFs) and their management targets may not be applicable to specific medical subpopulations, particularly dialysis patients. This study aimed to evaluate the dose-response association between measurements of RFs, cardiovascular mortality, and potential metabolic targets among Chinese patients initializing peritoneal dialysis (PD).

Risk-set sampling was applied to two population based 1: 10 case-control studies of incident PD patients, matched by age, sex and the year of initialisation of PD: a main sample (204 cases and 2,040 controls) and a replication sample (81 cases and 810 controls). The dose-response association between continuous measurements of CV RFs (blood pressure, fasting glucose, body mass index, total cholesterol, phosphate and ejection fraction) at baseline and the 2-year CV mortality were analyzed using conditional Logistic regression. The final threshold was chosen based upon a significant break in the regression coefficients and achievement of the minimum Bayesian information criterion (BIC).

A linear relationship was identified between fasting glucose and CV mortality. Non-linear associations between other measurements and CV mortality suggested potential metabolic treatment intensification thresholds as < 145/92mmHg for blood pressure, < 1.70mmol/L for phosphate, 24 kg/m2 for body mass index, 4.6mmol/L for total cholesterol, and > 60% for ejection fraction respectively.

Our findings highlight the potential importance of more intensive glucose management, anti-hypertensive treatment and dietary management among PD patients. We recommend that the clinical relevance of these epidemiological associations be tested using randomized controlled trials of multifaceted interventions.