Electrolyte Blood Press.  2019 Dec;17(2):36-44. 10.5049/EBP.2019.17.2.36.

Association of Blood Pressure at Specific Time-Points with 1-Year Renal Outcomes in Patients with Diabetic Chronic Kidney Disease

• Ryu JW
• Cha RH
• Lee H
• Kim YS
• Lee JP
• Song YR
• Kim SG
• Kim SJ

• KMID: 2467959
• DOI: http://doi.org/10.5049/EBP.2019.17.2.36

Abstract

BACKGROUND
The 24-hour mean blood pressure (mBP) is the best predictor of organ damage; however, it is not easily applicable in clinical practice. The APrODiTe study suggested that systolic blood pressure (SBP) values at 7:00 AM and 9:30 PM were associated with the 24-hour mSBP in patients with chronic kidney disease (CKD). We investigated the association of the SBP values at these time-points with the renal outcomes in patients with diabetic CKD during 1-year follow-up.
METHODS
Ninety-six patients with diabetic CKD were included at 1-year follow-up. The renal outcomes were an increase in the random urine protein/creatinine ratio or estimated glomerular filtration rate (eGFR) deterioration, which means a decrease in eGFR ≥5 mL/min/1.73 m² compared to the baseline values.
RESULTS
The baseline SBP values at 7:00 AM, and 9:30 PM, and the 24-hour mSBP were 135.6±24.9 mmHg, 141.7±25.6 mmHg, and 136.4±20.7 mmHg, respectively. The SBP values measured at the same time-points after 1 year were similar to those at baseline. The SBP at 7:00 AM was significantly associated with eGFR deterioration in the univariate and multivariate analyses (odds ratio [OR]: 1.032; 95% confidence interval [CI]: 1.006-1.059; p=0.016). The SBP at 7:00AM and 24-hour mSBP did not show a concordant association with sustained proteinuria in the linear and logistic analyses. In the subgroup analysis, the association between the SBP at 7:00 AM and eGFR deterioration persisted in patients with CKD stage 3-5 (OR: 1.041; 95% CI: 1.010-1.073; p=0.010).
CONCLUSION
The SBP at 7:00 AM, in addition to the 24-hour mSBP, is also associated with eGFR deterioration in patients with diabetic CKD, particularly in those with CKD stage 3-5.

Keyword

Blood pressure; Ambulatory blood pressure monitoring; Proteinuria; Diabetic nephropathies

MeSH Terms

Blood Pressure Monitoring, Ambulatory
Blood Pressure*
Diabetic Nephropathies
Follow-Up Studies
Glomerular Filtration Rate
Humans
Multivariate Analysis
Proteinuria
Renal Insufficiency, Chronic*

Figure

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  Fig. 1 The receiver operating characteristic (ROC) curve for decreased estimated glomerular filtration rate in Diabetic CKD patients.

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