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Kidney Week

Abstract: FR-PO369

Ambulatory Blood Pressure (ABP) Is More Important Risk Factor to Renal Outcome in CKD Patients Than Office Blood Pressures

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Son, Hyung Eun, Seoul National University Bundang Hospital, Seongnam, Gyeong-gido, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background


The prognosis of CKD is strongly associated with blood pressure. However, there are few clinical data suggesting which methods is better for measuring blood pressure and what is the target level of blood pressure to prevent CKD progression.

Methods


We enrolled 387 hypertensive CKD patients from three tertiary referral hospitals in Korea who underwent ABP monitoring and followed for 38.0 months. The primary renal outcome was an incident end stage renal disease (ESRD) which data was collected from the ESRD registry of the Korean Society of nephrology.

Results

The mean office blood pressure was 131.9/79.4 mmHg and the mean ABPs was 131.9/79.4 mmHg. The estimated glomerular filtration rate (GFR) and urine protein to creatinine ratio (UPCR) was 45.0 ± 21.6 ml/min/1.73 m2 and 1.545 ± 2.278 mg/mg creatinine, respectively. There were 13.4 % (52/387) incident ESRD. The risk factors for an incident ESRD were age, GFR, UPCR, product of calcium by phosphorous at renal biopsy and parameters of blood pressures, such as ambulatory systolic blood pressure (ASBP), ambulatory diastolic pressure (ADBP), ABP grouped by the criteria of 120/80, 130/80, and 140/90 mmHg. The rate of incident ESRD in patients with ABP < 120/80 mmHg was 1.2 %, with ABP 120/80-129/79 mmHg, 12.0 %, with 130/80-139/89 mmHg, 10.2 %, and, with ABP ≧ 140/90 mmHg, 25.4 % (p<0.001). The risk ratios of an incident ESRD in patients with ABP 120/79-129/79, 130/80-139/89, and ABP ≧ 140/90 mmHg were 10.643 (95% CI: 1.032-86.980, p=0.027), 7.489 (95% CI: 0.928-60.408, p=0.059), and 13.518 (95% CI: 1.792-101.952, p=0.012) compared to the risk of ESRD in patients with ABP < 120/80 mmHg, respectively (p for trend=0.002), adjusted by risk factors using the Cox's hazard proportional model.

Conclusion

Office blood pressure was not appropriate measurement to guide BP control in CKD patients. Lower criteria of ambulatory blood pressure would be recommended for prevention of ESRD in CKD patients.