Abstract
Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.
Highlights
End-stage renal disease (ESRD) has emerged as one of the most important public health issues
The highest quartile of the coefficient of variation (CV) for hemoglobin A1c (HbA1c) levels was associated with a 1.6-fold higher risk for diabetic nephropathy compared with the lowest quartile, and the highest quartile of the CV for fasting blood glucose (FBG) was associated with a 4.8-fold higher risk for diabetic nephropathy compared with the lowest quartile [23]
The results of the present study suggest that blood pressure (BP) variability is an independent risk factor for the development of end-stage renal disease (ESRD), regardless of the presence of chronic kidney disease (CKD)
Summary
End-stage renal disease (ESRD) has emerged as one of the most important public health issues. It is important to prevent the progression of ESRD through the early detection of people at high risk and treatment of modifiable factors. Recent interest in the intraindividual variability in various metabolic parameters has led to the recognition of their role as a risk factor for health-related outcomes [3,4,5,6,7,8]. Among people with type 2 DM, glucose variability is an independent predictor of ESRD after adjusting for other conventional risk factors, including mean glucose level [9]. Previous studies have identified BP variability as a risk factor for the progression of chronic kidney disease (CKD), strokes, and mortality [5]. BP variability is a compelling risk factor among patients undergoing hemodialysis [10]. Greater visit-to-visit BP variability has significant prognostic value and points to some potentially modifiable practice patterns, including antihypertensive agent selection, to achieve consistent BP levels
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