Kidney Week

Abstract: TH-PO1096

Lower Diastolic Blood Pressure Increases the Risk of Mortality and Progression to ESRD – Multicenter Large Cohort Study

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kim, Do Hyoung, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea (the Republic of)

Do Hyoung Kim,

• Kim, Yong Chul, Seoul National University Hospital, Seoul, Korea (the Republic of)

Yong Chul Kim,

• An, Jung Nam, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)

Jung Nam An,

• Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)

Dong Ki Kim,

• Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Yon Su Kim,

• Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)

Chun Soo Lim,

• Shin, Dong Ho, College of Medicine, Hallym University, Seoul, Korea (the Republic of)

Dong Ho Shin,

• Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)

Jung Pyo Lee,

Background

Higher systolic blood pressure (BP) is known to be associated with an increased risk of cardiovascular events and mortality in chronic kidney disease (CKD) patients. However, the clinical impacts of diastolic BP and the ideal diastolic BP target in Asian elderly CKD patients have not been well studied.

Methods

A multicenter CKD cohort from 2001 to 2016 was used. We examined the associations of systolic and diastolic BP with all-cause mortality and progression to end-stage renal disease (ESRD) using multivariate Cox proportional hazards regression models.

Results

A total of 13,700 patients with complete data for multivariable analysis were enrolled. Systolic BP showed a U-shaped association with mortality and a linear association with progression to ESRD. Systolic BP greater than 140 mmHg or diastolic BP less than 50 mmHg was significantly associated with higher mortality, regardless of the presence of diabetes or hypertension. In subgroup analysis of age, the patients with diastolic BP < 60 mmHg and aged < 50 years, or diastolic BP < 50 mmHg and aged < 70 years had a higher risk of mortality compared to those with diastolic BP 70-79 mmHg after adjusted systolic BP (age < 50, hazard ratios [HRs], 4.46; 95% confidence interval [95% CI], 2.38 to 8.35; age 50-59, HRs, 2.92; 95% CI, 1.33 to 6.38; age 60-69, HRs 2.84; 95% CI, 1.49 to 5.43). However, there was no association in those aged ≥ 70 years. The risk for progression to ESRD was also increased with diastolic BP < 60 mmHg (HRs 1.20; 95% CI, 1.01 to 1.43). The risk for mortality and progression to ESRD was also increased with diastolic BP < 60 mmHg in patients with diabetes (HRs 2.65; 95% CI, 1.67 to 4.22; HRs 1.43 95% CI 1.01-1.89).

Conclusion

In the CKD patients, lower diastolic BP was significantly associated with mortality and progression to ESRD; however, the effects were reduced in elderly patients (≥ 70 years).