ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2014
Troponin I and NT-proBNP and the association of systolic blood pressure with outcomes in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study.
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Management of blood pressure in adults, children and young people on dialysis: UK kidney association clinical practice guideline.BMC nephrology · 2025Guideline
- Peridialysis BP levels and risk of all-cause mortality: a dose-response meta-analysis.Journal of human hypertension · 2019Pooled it
- Evaluating the Prognostic Significance of Circulating Biomarkers of End Organ Damage in Hypertension.Journal of clinical medicine · 2025Review
- Cardiac Biomarkers Predict Major Adverse Cardiac Events (MACE) in Incident Haemodialysis Patients: Results from a Global Federated Database.Biomedicines · 2025Article
- Hypertension in Dialysis Patients: Diagnostic Approaches and Evaluation of Epidemiology.Diagnostics (Basel, Switzerland) · 2022Review
- Routinely measured cardiac troponin I and N-terminal pro-B-type natriuretic peptide as predictors of mortality in haemodialysis patients.ESC heart failure · 2022Article
- NT-proBNP as a Potential Marker of Cardiovascular Damage in Children with Chronic Kidney Disease.Journal of clinical medicine · 2021Article
- Blood pressure target for the dialysis patient.Seminars in dialysis · 2019Review
- Blood Pressure and Risk of Cardiovascular Events in Patients on Chronic Hemodialysis: The CRIC Study (Chronic Renal Insufficiency Cohort).Hypertension (Dallas, Tex. : 1979) · 2017Article
- Plasma N-Terminal Probrain Natriuretic Peptide, Vascular Endothelial Growth Factor, and Cardiac Troponin I as Novel Biomarkers of Hypertensive Disease and Target Organ Damage in Cats.Journal of veterinary internal medicine · 2017Article
- Blood Pressure and Mortality in Long-Term Hemodialysis-Time to Move Forward.American journal of hypertension · 2017Review
- Observational
- Race, Mineral Homeostasis and Mortality in Patients with End-Stage Renal Disease on Dialysis.American journal of nephrology · 2015Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundThere is uncertainty regarding treatment of hypertension in hemodialysis patients due to the observed J-shaped association between blood pressure (BP) and death. We hypothesized that this association reflects confounding by cardiovascular disease (CVD) and that stratification by CVD biomarkers, cardiac troponin I (cTnI) and N-terminal fragment of prohormone brain natriuretic peptide (NT-proBNP), might change this association. STUDY
designNational prospective cohort study. SETTING &
participants446 incident hemodialysis patients. PREDICTOR: Predialysis systolic BP. OUTCOMES: Mortality (all-cause and CVD) and first CVD event assessed using Cox regression adjusted for demographics, comorbid conditions, and clinical factors. MEASUREMENTS: Participants with cTnI level ≥0.1 ng/mL or NT-proBNP level ≥9,252 pg/mL were classified as the high-biomarker group; remaining participants were included in the low-biomarker group.
resultsParticipants in the high-biomarker group (n=138 [31%]) were older (61 vs. 57 years) and had a higher prevalence of CVD (67% vs. 23%), but similar baseline BPs (152 vs. 153 mm Hg). There were 323 deaths (143 from CVD) and 271 CVD events. The high-biomarker group had a higher risk of mortality than the low-biomarker group (HR, 1.75; 95% CI, 1.37-2.24). The association between BP and outcomes differed between the 2 biomarker groups (P for interaction=0.01, 0.2, and 0.07 for all-cause mortality, CVD mortality, and first CVD event, respectively). In the low-biomarker group, BP was associated with greater risk of outcomes: HR per 10 mm Hg higher BP was 1.07 (95% CI, 1.01-1.14), 1.10 (95% CI, 0.96-1.25), and 1.04 (95% CI, 0.96-1.13) for all-cause mortality, CVD mortality, and first CVD event, respectively. Importantly, lower BP was not associated with increased risk of outcomes in stratified models, including for those in high biomarker group. LIMITATIONS: BP measurements not standardized.
conclusionsThe observed J-shaped association between BP and outcomes in hemodialysis patients is due to confounding by subclinical CVD. A stratification approach based on cTnI and NT-proBNP levels has the potential to inform BP treatment in hemodialysis patients.
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