CHAPTER 8: Blood Pressure Control and Dyslipidaemia in Patients on Dialysis S. Prasad Menon Hooi Lai Seong Lee Wan Tin Sunita Bavanandan Source: 21 st.

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CHAPTER 8: Blood Pressure Control and Dyslipidaemia in Patients on Dialysis S. Prasad Menon Hooi Lai Seong Lee Wan Tin Sunita Bavanandan Source: 21 st MDTR Report 2013, NRR

Table 8.1.1: Distribution of pre dialysis systolic blood pressure, HD patients Year Number of patients MeanSDMedianLQUQ % Patients <120 mmHg % Patients 120-<140 mmHg % Patients 140-<160 mmHg % Patients 160-<180 mmHg % Patients ≥180 mmHg

Source: 21 st MDTR Report 2013, NRR Figure 8.1.1: Cumulative distribution of pre dialysis systolic blood pressure, HD patients

Source: 21 st MDTR Report 2013, NRR Table 8.1.2: Distribution of pre dialysis systolic blood pressure, PD patients Year Number of patients MeanSDMedianLQUQ % Patients <120 mmHg % Patients 120-<140 mmHg % Patients 140-<160 mmHg % Patients 160-<180 mmHg % Patients ≥180 mmHg

Source: 21 st MDTR Report 2013, NRR Figure 8.1.2: Distribution of pre dialysis systolic blood pressure, PD patients

Source: 21 st MDTR Report 2013, NRR Table 8.1.3: Distribution of pre dialysis diastolic blood pressure, HD patients Year Number of patients MeanSDMedianLQUQ % Patients <70 mmHg % Patients 70-<80 mmHg % Patients 80-<90 mmHg % Patients 90-<100 mmHg % Patients ≥100 mmHg

Source: 21 st MDTR Report 2013, NRR Figure 8.1.3: Cumulative distribution of pre dialysis diastolic blood pressure, HD patients

Source: 21 st MDTR Report 2013, NRR Table 8.1.4: Distribution of pre dialysis diastolic blood pressure, PD patients Year Number of patients MeanSDMedianLQUQ % Patients <70 mmHg % Patients 70-<80 mmHg % Patients 80-<90 mmHg % Patients 90-<100 mmHg % Patients ≥100 mmHg

Source: 21 st MDTR Report 2013, NRR Figure 8.1.4: Cumulative Distribution of pre dialysis diastolic blood pressure, PD patients

Source: 21 st MDTR Report 2013, NRR Table 8.1.5(a): Median systolic blood pressure among HD patients, HD centres Year Number of centres Min 5 th Centile LQ Media n UQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.1.5(a): Variation in median systolic blood pressure among HD patients, HD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.1.5(b): Median diastolic blood pressure among HD patients, HD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.1.5(b): Variation in median diastolic blood pressure among HD patients, HD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.1.5(c): Proportion of HD patients with pre dialysis blood pressure <140/90 mmHg, HD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.1.5(c): Variation in proportion of HD patients with pre dialysis blood pressure <140/90 mmHg, HD centers 2013

Source: 21 st MDTR Report 2013, NRR Table 8.1.6(a): Median systolic blood pressure among PD patients, PD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.1.6(a): Variation in median systolic blood pressure among PD patients, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.1.6(b): Median diastolic blood pressure among PD patients, PD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.1.6(b): Variation in median diastolic blood pressure among PD patients, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.1.6(c): Proportion of PD patients with pre dialysis blood pressure <140/90 mmHg, PD centres Year Number of centre Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.1.6(c): Variation in proportion of PD patients with pre dialysis blood pressure < 140/90 mmHg, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.1.7(a): Correlation of blood pressure profile and death, cardiovascular death and ischaemic heart disease, dialysis patients SBP<120 and DBP<70 (I) SBP and DBP (II) SBP and DBP (III) SBP and DBP (IV) SBP>=180 and DBP>=100 (V) n%n%n%n%n% Men n Death CVD/IHD Women n Death CVD/IHD

Source: 21 st MDTR Report 2013, NRR Figure 8.1.7(a): Relationship between blood pressure and death in dialysis patients

Source: 21 st MDTR Report 2013, NRR Table 8.1.7(b): Hazard ratio for death in each of the blood pressure categories, SBP<120 and DBP<70 * Ref. SBP and DBP SBP and DBP SBP and DBP SBP>=180 and DBP>=100 Men n Hazard ratio % CI (0.445 ; 0.581)(0.271 ; 0.35)(0.295 ; 0.404)(0.575 ; 0.965) p-value < Women n Hazard ratio % CI (0.452 ; 0.611)(0.352 ; 0.471)(0.452 ; 0.671)(1.285 ; 2.411) p-value <0.001

Source: 21 st MDTR Report 2013, NRR Table 8.2.1: Distribution of serum cholesterol, HD patients Year Number of patients MeanSDMedianLQUQ % patients <3.5 mmol/L % patients 3.5-<5.3 mmol/L % patients 5.3-<6.2 mmol/L % patients ≥6.2 Mmol/L

Source: 21 st MDTR Report 2013, NRR Figure 8.2.1: Cumulative distribution of cholesterol, HD patients

Source: 21 st MDTR Report 2013, NRR Table 8.2.2: Distribution of serum cholesterol, PD patients Year Number of patients MeanSDMedianLQUQ % patients <3.5 mmol/L % patients 3.5-<5.3 mmol/L % patients 5.3-<6.2 mmol/L % patients ≥6.2 mmol/L

Source: 21 st MDTR Report 2013, NRR Figure 8.2.2: Cumulative distribution of cholesterol (mmol/L), PD patients

Source: 21 st MDTR Report 2013, NRR Table 8.2.3: Distribution of serum triglyceride, HD patients Year Number of patients MeanSDMedianLQUQ % patients <1.7 mmol/L % patients 1.7-<2.3 mmol/L % patients 2.3-<3.5 mmol/L % patients ≥3.5 mmol/L

Source: 21 st MDTR Report 2013, NRR Figure 8.2.3: Cumulative distribution of serum triglyceride, HD patients

Source: 21 st MDTR Report 2013, NRR Table 8.2.4: Distribution of serum triglyceride, PD patients Year Number of patients MeanSDMedianLQUQ % patients <1.7 mmol/L % patients 1.7-<2.3 mmol/L % patients 2.3-<3.5 mmol/L % patients ≥3.5 mmol/L

Source: 21 st MDTR Report 2013, NRR Figure 8.2.4: Cumulative distribution of serum triglyceride, PD patients

Source: 21 st MDTR Report 2013, NRR Table 8.2.5(a): Median serum cholesterol level among HD patients, HD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.5(a): Variation in median serum cholesterol level among HD patients, HD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.5(b): Proportion of HD patients with serum cholesterol <5.3mmol/L, HD centres Year Number of centre Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.5(b): Variation in proportion of patients with serum cholesterol <5.3 mmol/L, HD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.5(c): Median serum triglyceride level among HD patients, HD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.5(c): Variation in median serum triglyceride level among HD patients, HD centers 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.5(d): Proportion of HD patients with serum triglyceride <2.1 mmol/L, HD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.5(d): Variation in proportion of patients with serum triglyceride <2.1mmol/L, HD centers 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.6(a): Median serum cholesterol level among PD patients, PD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.6(a): Variation in median serum cholesterol level among PD patients, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.6(b): Proportion of PD patients with serum cholesterol <5.3 mmol/L, PD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.6(b): Variation in proportion of patients with serum cholesterol <5.3 mmol/L, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.6(c): Median serum triglyceride level among PD patients, PD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.6(c): Variation in median serum triglyceride level among PD patients, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.6(d): Proportion of PD patients with serum triglyceride < 2.1 mmol/L, PD centres Year Number of centres Min 5 th Centile LQMedianUQ 95 th Centile Max

Source: 21 st MDTR Report 2013, NRR Figure 8.2.6(d): Variation in proportion of patients with serum triglyceride <2.1 mmol/L, PD centres 2013

Source: 21 st MDTR Report 2013, NRR Table 8.2.7(a): Relationship of different categories of cholesterol levels with death, dialysis patients <3.5 mmol/L 3.5-<5.3 mmol/L 5.3-<6.2 mmol/L >=6.2 mmol/L n%n%n%n% Men n Death CVD/IHD Women n Death CVD/IHD

Source: 21 st MDTR Report 2013, NRR Figure 8.2.7(a): Relationship between serum cholesterol categories and death, dialysis patients

Source: 21 st MDTR Report 2013, NRR Table 8.2.7(b): Hazard ratio for death in each of the total cholesterol categories, dialysis patient <3.5 mmol/L Ref. 3.5-<5.3 mmol/L 5.3-<6.2 mmol/L >=6.2 mmol/L Men n Hazard ratio % CI (0.601 ; 0.675)(0.654 ; 0.767)(0.971 ; 1.227) p-value < Women n Hazard ratio % CI (0.44 ; 0.523)(0.448 ; 0.543)(0.649 ; 0.81) p-value <0.001