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Kidney Week

Abstract: FR-PO270

Ambulatory Blood Pressure Patterns, Cognitive Function, and Frailty in CKD: Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Ghazi, Lama, University of Minnesota, Saint Paul, Minnesota, United States
  • Yaffe, Kristine, UCSF, San Francisco, California, United States
  • Kurella Tamura, Manjula, Stanford University, Palo Alto, California, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
  • Cohen, Jordana B., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
  • Fischer, Michael J., University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, United States
  • Miller, Edgar R., Johns Hopkins University, Baltimore, Maryland, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Sugar Land, Texas, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Townsend, Raymond R., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
  • Cohen, Debbie L., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Drawz, Paul E., University of Minnesota, Saint Paul, Minnesota, United States
Background

Hypertension (HTN) is highly prevalent in patients with chronic kidney disease (CKD) as is the risk of cognitive impairment and frailty. Our objective was to determine the association between ambulatory blood pressure (BP) patterns, cognitive impairment and frailty among patients with CKD.

Methods

We performed ambulatory BP monitoring (ABPM) on 1502 participants enrolled in CRIC. We evaluated the following exposures: 1) BP patterns: white-coat, masked, sustained HTN vs. controlled HTN and 2) dipping patterns: reverse, extreme, non dippers vs. normal dippers. Our outcomes included: 1) cognitive impairment: modified mini-mental status (3MS) score <85 for participants <65yrs, score <80 for 65-79 yrs and score <75 for >80yrs and 2) frailty: defined as meeting ≥3 of the following criteria - slow gait speed, muscle weakness, low physical activity, exhaustion and unintentional weight loss. Both outcomes were assessed at the time of ABPM and annually thereafter. Logistic regression models were used to assess the cross-sectional relationship between BP or dipping patterns and cognitive impairment and frailty. For longitudinal analysis, Cox discrete models were used.

Results

Mean age of the participants was 63 yrs, 56% were male, and 39% were Black. 9%(n=129) had cognitive impairment and 18%(n=275) were frail at the time of ABPM. After multivariable adjustment, there was no association between any BP or dipping patterns and prevalent cognitive impairment or frailty. 629 participants had incident frailty and 255 had incident cognitive impairment over a median follow up of 3 yrs. After adjustment, participants with white-coat HTN had 0.6 times the risk of incident frailty compared to controlled HTN [95%CI: 0.4, 0.9]. Participants with reverse dipping had marginally greater incident cognitive impairment compared to normal dippers (HR=1.5, 95% CI: 1, 2.3).

Conclusion

CKD patients with white-coat HTN have lower rates of incident frailty compared to controlled HTN. There was no consistent association between BP or dipping patterns and incident or prevalent cognitive impairment or prevalent frailty.