1513-P: Severity of Hypertension (HT) as a Predictor of Initiation of Dialysis among Study Participants with and without Diabetes Mellitus (DM)

Abstract

Although both hyperglycemia and HT are highly predictive of kidney disease, only a few studies have investigated the associations between the severity of HT and risk of end-stage renal disease especially the initiation of renal replacement therapy in DM+ or DM- in the same cohort at the same time. Thus, we analyzed data from a nationwide claim database involving 258,874 participants during 2008-16. Multivariate Cox regression model was used to identify risks of starting dialysis. HT as a covariate was determined according to systolic blood pressure (SBP)(mmHg) diagnosed by seven different cut-offs (≥110, ≥115, ≥120, ≥125, ≥130, ≥140, ≥150). Hazard ratios (HRs) were compared among 10 groups divided according to combinations of DM+ or DM- and five levels of SBP (mmHg) (≤119, 120-129, 130-139, 140-149, ≥150). Among DM-, baseline age, percent of men, BMI, smoking rate, SBP, and percent of medication for HT were higher in those who started dialysis. In those with DM+, baseline percent of men, SBP, and percent of medication for DM and HT were higher in those who started dialysis. HT was significantly associated with the initiation of dialysis regardless of the presence or absence of DM. The incidence of starting dialysis in those with SBP ≤119 mmHg and DM+ was almost the same as in those with SBP ≥150 mmHg and DM-. In comparison with SBP ≤119 mmHg, SBP ≥150 mmHg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM-. Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150 mmHg was 6.88 (95% CI 3.66-12.9). Although the risks of HT differed only slightly regardless of the presence or absence of DM, risks for the initiation of dialysis with DM+ and SBP ≤119 mmHg were equivalent to DM- and SBP ≥150 mmHg, indicating stricter blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are needed to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure. Disclosure T. Osawa: None. K. Fujihara: None. M.H. Yamada: None. T. Sato: None. M. Kitazawa: None. Y. Yaguchi: None. Y. Matsubayashi: None. M. Iwanaga: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. Funding Japan Society for the Promotion of Science