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

To determine associations between severity of hypertension and risk of starting dialysis in the presence or absence of diabetes mellitus (DM). A nationwide database with claims data on 258 874 people with and without DM aged 19-72 years in Japan was used to elucidate the impact of severity of hypertension on starting dialysis. Initiation of dialysis was determined from claims using International Classification of Diseases-10 codes and medical procedures. Using multivariate Cox modeling, we investigated the severity of hypertension to predict the initiation of dialysis with and without DM. Hypertension was significantly associated with the initiation of dialysis regardless of DM. The incidence of starting dialysis in those with systolic blood pressure (SBP) <= 119 mm Hg and DM (DM+) was almost the same as in those with SBP >= 150 mm Hg and absence of DM (DM-). In comparison with SBP <= 119 mm Hg, SBP >= 150 mm Hg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM-. Compared with DM- and SBP <= 119 mm Hg, the HR for DM+ and SBP >= 150 mm Hg was 6.88 (95% CI 3.66 to 12.9). Although the risks of hypertension differed only slightly regardless of the presence or absence of DM, risks for starting dialysis with DM+ and SBP <= 119 mm Hg were equivalent to DM- and SBP >= 150 mm Hg, indicating more strict blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are required to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure.

Automated summary

Hypertension is significantly associated with the initiation of dialysis regardless of the presence of diabetes mellitus. Patients with diabetes mellitus may require more strict blood pressure interventions to avoid dialysis compared to those without diabetes and higher systolic blood pressure levels. Future studies are needed to determine the cut-off systolic blood pressure level to prevent initiation of dialysis.