Abstract
Non-dipping nocturnal blood pressure (BP) pattern is a predictor of the future decline of renal function; however, it is unclear whether it is still a risk for chronic kidney disease (CKD) patients with normal BP. To solve this question, a retrospective cohort study was conducted, and 1107 CKD patients who underwent ambulatory blood pressure monitoring (ABPM) were enrolled. We divided patients into 4 groups based on their nocturnal BP dipping pattern (dipper or non-dipper) and average 24-hour BP (hypertension or normotension). The cumulative incidence of composite renal outcomes, including a 40% reduction in eGFR, the induction of renal-replacement therapy, or death from renal causes, was analyzed. Overall, 86.1% of participants were non-dippers and 48.2% of them were normotensive. During the median follow-up period of 4.72 years, the incidence of renal composite outcomes was highest in hypertensive non-dipper patients, and was similar between normotensive dipper and non-dipper patients. Multivariate regression analysis revealed that the 24-hour systolic BP, amount of urinary protein, and hemoglobin values were associated with the incidence of renal outcomes. In conclusion, our ABPM-based analysis revealed that a non-dipping BP pattern with normotension does not predict the future incidence of composite renal outcomes in CKD patients.
Highlights
Non-dipping nocturnal blood pressure (BP) pattern is a predictor of the future decline of renal function; it is unclear whether it is still a risk for chronic kidney disease (CKD) patients with normal BP
Based on previous studies demonstrating the non-dipping BP pattern to increase the risk of developing ESRD19, our clinical investigation was performed in order to clarify the impact of the non-dipping pattern of BP on the incidence of composite renal outcomes in normotensive CKD patients
A major result of this retrospective cohort study using ambulatory blood pressure monitoring (ABPM) was that the normotensive non-dipper pattern was not a risk for the future incidence of renal www.nature.com/scientificreports composite outcomes
Summary
Non-dipping nocturnal blood pressure (BP) pattern is a predictor of the future decline of renal function; it is unclear whether it is still a risk for chronic kidney disease (CKD) patients with normal BP. Our ABPM-based analysis revealed that a non-dipping BP pattern with normotension does not predict the future incidence of composite renal outcomes in CKD patients. The observation period in our recent study was insufficient to conclude that the 24-hour average BP, rather than its circadian rhythm, is an important predictor of the future incidence of ESRD To overcome this limitation, we conducted a retrospective cohort study to elucidate the impact of actual BP values or its circadian rhythm on the long-term incidence of renal outcomes, including a 40% reduction in eGFR, the induction of renal-replacement therapy, or death from renal causes. We divided CKD patients into four categories according to ABPM findings, i.e., 24-hour BP values and BP dipping patterns, and compared the cumulative incidence of composite renal outcomes
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