UK Renal Registry 12th Annual Report (December 2009): Chapter 11 Blood Pressure Profile of Prevalent Patients Receiving Dialysis in the UK in 2008: national and centre-specific analyses

Introduction: The UK Renal Registry (UKRR) assesses blood pressure (BP) control annually for patients receiving renal replacement therapy (RRT) at renal centres in England, Wales and Northern Ireland. Methods: Patients alive and receiving RRT on 31st December 2008 with a BP reading in either the fourth or third quarter of 2008 were included. Summary statistics were calculated for each renal centre, nation and primary renal disease (PRD) category. Longitudinal analyses were performed to assess the long-term impact of treatment modality and PRD on BP control for incident and prevalent patients. Results: In 2008, only 26.3% of peritoneal dialysis (PD) and 27.4% of transplant (Tx) patients achieved the Renal Association (RA) guidelines standard of BP <130/80 mmHg. Since the cessation of BP targets for haemodialysis (HD) patients, there has been a reduction (compared to 2007) in the number of HD patients achieving BP <130/80 mmHg. In 2008, 43.1% of patients achieved BP < 140/90 mmHg pre-HD and 46.8% BP <130/80 mmHg post-HD. BP control varied significantly between renal centres for each treatment modality (p < 0.001). Adjusted mean systolic BP fell significantly during the first year on dialysis (6 mmHg for PD and 8 mmHg for HD). Hypertension was more common in HD patients with vascular disorders such as diabetes and renovascular disease (59.0%) than in patients with glomerulonephritis (51.9%) or tubular disorders (46.7%). Conclusions: In 2008, a minority of patients on RRT achieved the recommended BP standards. There remained a significant variation in achievement of standards between UK renal centres. Since the removal of specific BP targets for HD patients, there has been an increase in systolic BP pre- and post-HD. BP falls significantly during the first year after starting dialysis and patients with vascular disorders have significantly worse BP control.