Severity of hypertension as a predictor of initiation of dialysis among
study participants with and without diabetes mellitus
Abstract
Aims: To determine associations between severity of hypertension and
risk of starting dialysis in the presence or absence of diabetes
mellitus (DM). Methods: A nationwide database with claims data on
258,874 people with and without DM aged 19-72 y in Japan was used to
elucidate the impact of severity of hypertension on starting dialysis.
Initiation of dialysis was determined from claims using ICD-10 codes and
medical procedures. Using multivariate Cox modeling, we investigated
severity of hypertension as a predictor of the initiation of dialysis
with and without DM. Results: Hypertension was significantly associated
with the initiation of dialysis regardless of DM. The incidence of
starting dialysis in those with SBP ≤119 mmHg and DM (DM+) was almost
the same as in those with SBP ≥150 mmHg and absence of DM (DM-). In
comparison with SBP ≤119 mmHg, SBP ≥150 mmHg significantly increased the
risk of the initiation of dialysis about 2.5 times regardless of DM+ or
DM-. Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150
mmHg was 6.88 (95% CI 3.66-12.9). Conclusions: Although the risks of
hypertension differed only slightly regardless of the presence or
absence of DM, risks for the initiation of dialysis with DM+ and SBP
≤119 mmHg were equivalent to DM- and SBP ≥150 mmHg, indicating more
strict blood pressure interventions in DM+ are needed to avoid dialysis.
Future studies are needed to clarify the cut-off SBP level to avoid
initiation of dialysis considering the risks of strict control of blood
pressure.