Optimal cut-off threshold in pulse pressure predicting cardiovascular death among newly diagnosed end-stage renal disease patients: A prospective cohort study

Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage renal disease (ESRD) treated by dialysis. Pulse pressure (PP) as an independent prognostic factor of cardiovascular risk might be clinically implicated in predicting the short-term deaths due to cardiovascular diseases in ESRD patients. This study aimed to investigate the dose-response association between PP and risk of cardiovascular mortality in patients initializing peritoneal dialysis (PD). All patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2014 were incorporated in the current cohort study. PP was assessed by the date of initialisation of PD and cardiovascular mortality in 2 years after the initialisation of PD was defined as the outcome. All accessible clinical measurements were screened as covariables. Further dose-response relationships between PP and risks were explored using spline models. There was a non-linear relationship between PP and the risk of 2-year death for a cardiovascular diseases (P <.001 for linearity test). The PP associated with the lowest risk of cardiovascular mortality was 61 (95% CI 56-64) mmHg. In ESRD patients initializing PD, PP is a good prognostic factor of risk of short-term cardiovascular mortality. The risk is lowest with a PP of 56 to 64 mmHg.