Abstract
BackgroundThe variability of visit-to-visit (VVV) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) is proved as a predictor of renal function deterioration in patients with non-diabetic chronic kidney disease. The purpose of this study was to investigate the relationship of the variability in SBP and the magnitude of renal function impairment for normal renal function patients in the first 10-years diagnosed with type II diabetes mellitus (DM).MethodsWe retrospectively reviewed the electronic medical records of 789 patients who were first diagnosed with diabetes mellitus during 2000–2002 and regularly followed for 10 years with a total of 53,284 clinic visits. The stages of Chronic Kidney Disease (CKD) of every patient were determined using estimated glomerular filtration rate. The occurrence of nephropathy was defined in those patients whose CKD stages elevated equal or larger than three.ResultsPatients were categorized according to the VVV of systolic and diastolic BP into three groups. Patients with high VVV of both SBP and DBP had a 2.44 fold (95% CI: 1.88–3.17, p < 0.001) increased risk of renal function impairment compared with patients with low VVV of both SBP and DBP. Risk of renal function impairment for patients with high VVV of either SBP or DBP had a 1.43-fold increase (95% CI: 1.08–1.89, p = 0.012) compared with patients with low VVV of both SBP and DBP. Cox regression analysis also demonstrated that every 1-year increase of DM diagnosed age significantly raised the risk of renal function impairment with a hazard ration of 1.05 (95% CI: 1.04–1.06, p < 0.001).ConclusionsNot only VVV of SBP but also VVV in DBP is correlated with diabetic nephropathy in the first decade for patients diagnosed with type 2 DM.
Highlights
The variability of visit-to-visit (VVV) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) is proved as a predictor of renal function deterioration in patients with non-diabetic chronic kidney disease
In patients with diabetes mellitus (DM), several risk factors including mean blood pressure (BP), albuminuria, high hemoglobin SBP systolic blood pressure (A1c) and serum cholesterol have been shown to accelerate the progression of chronic kidney disease (CKD) [3, 4]
Type 2 DM was diagnosed in accordance with the criteria of Definition of CKD and renal function impairment Serial serum creatinine data were collected and estimated glomerular filtration rate (eGFR) was determined by the abbreviated CKD Epidemiology Collaboration equation [15]
Summary
The variability of visit-to-visit (VVV) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) is proved as a predictor of renal function deterioration in patients with non-diabetic chronic kidney disease. The purpose of this study was to investigate the relationship of the variability in SBP and the magnitude of renal function impairment for normal renal function patients in the first 10-years diagnosed with type II diabetes mellitus (DM). In diabetic patients with CKD, the decline of the glomerular filtration rate (GFR) is highly variable, ranging from 2 to 20 mL/min/year [3]. Controversy existed as some of these factors contributed to renal function impairment in diabetic patients [5]. To identify the risk factors of renal function deterioration is important for development of prevention modalities in diabetic patients’ treatment. In clinical diabetic treatment guideline [6], absolute BP is used as a therapeutic target to prevent clinical stroke and heart disease, as well as CKD with paucity of evidence [7]
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