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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus

Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
DOI: 10.1136/jim-2020-001489 Published 4 March 2021
Taeko Osawa
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Kazuya Fujihara
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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  • ORCID record for Kazuya Fujihara
Mayuko Harada Yamada
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Masahiko Yamamoto
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Masaru Kitazawa
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Yasuhiro Matsubayashi
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Midori Iwanaga
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Takaho Yamada
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Hiroyasu Seida
2 Japan Medical Data Center Co Ltd, Tokyo, Japan
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Satoru Kodama
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Yoshimi Nakagawa
3 Department of Internal Medicine, University of Tsukuba School of Medicine, Tsukuba, Japan
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Hitoshi Shimano
3 Department of Internal Medicine, University of Tsukuba School of Medicine, Tsukuba, Japan
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Hirohito Sone
1 Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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    Figure 1

    Kaplan-Meier analysis of unadjusted overall time to initiation of dialysis. (A) Kaplan-Meier analysis of unadjusted overall time to initiation of dialysis for five groups without DM according to SBP (≤119 or 120–129 or 130–139 or 140–149 or ≥150 mm Hg). (B) Kaplan-Meier analysis of unadjusted overall time to initiation of dialysis for five groups with DM according to SBP (≤119 or 120–129 or 130–139 or 140–149 or ≥150 mm Hg). DM, diabetes mellitus; SBP, systolic blood pressure.

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  • Table 1

    Characteristics of study participants according to presence or absence of diabetes and dialysis

    TotalDiabetes mellitus (−)P valueDiabetes mellitus (+)P value
    DialysisDialysis
    (−)(+)(−)(+)
    (n=258 874)(n=241 515)(n=113)(n=17 170)(n=76)
    Age (years)45±9 44±9 47±8 <0.001 50±850±80.947
    Sex (male, %)161 007 (62) 146 602 (61) 91 (81) <0.001 14 243 (83) 71 (93) 0.015
    Body mass index (kg/m2)22.8±3.6 22.6±3.4 23.6±4.0 0.003 26.1±4.626.8±4.60.126
    Smoking (%)71 904 (28) 65 365 (27) 44 (39) 0.005 6462 (38)33 (43)0.299
    Systolic blood pressure (mm Hg)120±16 119±15 129±21 <0.001 131±17 140±21 <0.001
    Diastolic blood pressure (mm Hg)74±11 73±11 79±15 <0.001 80±1183±110.078
    HbA1c (%)5.5±0.75.4±0.35.5±0.40.243 7.2±1.4 7.8±2.1 0.015
    LDL cholesterol (mmol/L)3.1±0.83.1±0.83.0±0.90.4703.3±0.93.3±1.10.814
    HDL cholesterol (mmol/L)1.6±0.4 1.7±0.4 1.4±0.4 <0.001 1.4±0.4 1.3±0.4 <0.001
    Medication for diabetes (%)8136 (3)––– 8080 (47) 56 (74) <0.001
    Medication for hypertension (%)21 103 (8) 15 777 (7) 51 (45) <0.001 5218 (30) 57 (75) <0.001
    Prevalence of coronary artery disease (%)13 055 (5) 10 601 (4) 37 (33) <0.001 2382 (14) 35 (46) <0.001
    • Data are presented as numbers, means±SD or percentages

    • Values in bold are of statistical significance (P<0.05)

    • HbA1c, glycated hemoglobin A1c; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

  • Table 2

    Cox regression analysis of variables for the incidence of dialysis in participants with and without diabetes mellitus (DM)

    AB
    TotalDM (−)DM (+)
    Diabetes 3.41 (2.45 to 4.76)
    SBP mm Hg
    <110/≥1100.98 (0.57 to 1.66)1.31 (0.41 to 4.21)
    <115/≥1151.30 (0.81 to 2.11)1.75 (0.70 to 4.38)
    <120/≥1201.14 (0.75 to 1.75)1.47 (0.75 to 2.99)
    <125/≥1251.34 (0.89 to 2.01)1.67 (0.94 to 2.97)
    <130/≥1301.35 (0.90 to 2.02)1.42 (0.87 to 2.31)
    <140/≥140 2.01 (1.28to 3.16)1.44 (0.90to 2.30)
    <150/≥150 2.82 (1.67to 4.77) 1.81 (1.06to 3.07)
    • Baseline variables for predictors of dialysis adjusted by age, sex, smoking, medication for hypertension, BMI, LDL-C and HDL-C.

    • (A) Adjusted for age, sex, smoking, medication for hypertension, BMI, LDL-C, HDL-C and DM. (B) Adjusted for age, sex, smoking, medication for hypertension, BMI, LDL-C, HDL-C and SBP (≥110 or ≥115 or ≥120 or ≥125 or ≥130 or ≥140 or ≥150 mm Hg).

    • Values in bold are of statistical significance (P<0.05)

    • BMI, body mass index; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure.

  • Table 3

    HRs for initiation of dialysis according to combinations of DM and SBP

    SBP mm HgDM (−)DM (+)
    HR (95% CI)
    ≤1191.00 (ref.)1.00 (ref.)
    120–1290.98 (0.58 to 1.64)1.22 (0.55 to 2.70)
    130–1390.94 (0.52 to 1.67)1.41 (0.65 to 3.04)
    140–1491.28 (0.63 to 2.61)1.31 (0.55 to 3.14)
    ≥150 2.87 (1.55 to 5.32) 2.28 (1.03 to 5.01)
    ≤1191.00 (ref.) 3.01 (1.45 to 6.25)
    120–1290.97 (0.58 to 1.62) 3.70 (1.96 to 7.00)
    130–1390.95 (0.54 to 1.68) 4.26 (2.32 to 7.81)
    140–1491.31 (0.65 to 2.65) 3.94 (1.89 to 8.19)
    ≥150 3.00 (1.65 to 5.44) 6.88 (3.66 to 12.9)
    • HR for the initiation of dialysis compared with the combination of DM (−) and SBP ≤119 mm Hg/DM (+) and SBP ≤119 mm Hg as a reference group. Baseline variables as predictors for dialysis adjusted by age, sex, smoking, medication for hypertension, BMI, LDL-C and HDL-C.

    • **Values in bold are statistical significance (P <0.05).

    • **

    • DM, diabetes mellitus; SBP, systolic blood pressure; BMI, body mass index; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol.

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    [jim-2020-001489supp001.pdf]

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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
Journal of Investigative Medicine Mar 2021, 69 (3) 724-729; DOI: 10.1136/jim-2020-001489

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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
Journal of Investigative Medicine Mar 2021, 69 (3) 724-729; DOI: 10.1136/jim-2020-001489
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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
Journal of Investigative Medicine Mar 2021, 69 (3) 724-729; DOI: 10.1136/jim-2020-001489
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