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Kidney Week

Abstract: SA-PO928

Effect of Blood Pressure Variability and Arterial Stiffness for Renal Outcome in Patients with CKD Stage 3 or 4

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Park, Yun Hee, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
  • Kim, Yunmi, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
  • Kang, Sunwoo, Inje University, Busan, Busan, Korea (the Republic of)
  • Kim, Yeong Hoon, Inje University Medical School, Busan, Korea (the Republic of)
  • Kim, Taehee, Inje University, Busan, Busan, Korea (the Republic of)
Background

Previous studies have reported that higher visit-to-visit blood pressure (BP) variability is higher risk of decreased renal function in hypertensive individuals. Arterial stiffness is associated with decline of renal function. We examined the association between BP variability and renal outcome in patients with chronic kidney disease (CKD) stage 3 or 4, and whether theses renal outcomes were associated with arterial stiffness.

Methods

Among 2238 CKD patients in Korea in 2011 through 2017, 1241 patients who had CKD stage 3 or 4, and measured BP more than 3 times during follow-up period were included. BP variability was defined as standard deviation (SD) of systolic BP across 3 to 8 visits. SD was divided into quintiles. Composite renal outcome included ≥ 50% reduction of eGFR, dialysis or transplantation. Arterial stiffness was measured with brachial-ankle pulse wave velocity (baPWV). We calculated adjusted hazard ratio (AHR) for composite renal outcome across SD quintile and analyzed the effect of baPWV.

Results

Mean age was 53.6±11.1 years, 37% was women, and mean estimated glomerular filtration rate was 36.9±12.2 ml/min/1.73m2. Median follow-up was 3.0 years and 391 outcomes occurred. The AHR for composite renal outcome were 1.10 (95% confidence interval [95% CI]: 0.77-1.58), 1.19 (95% CI: 0.84-1.68), 1.30 (95% CI: 0.92-1.83), and 1.62 (95% CI: 1.15-2.28) for second through fifth versus the first quintile of SD. baPWV >15 m/s was significantly higher risk for renal outcomes in fifth compared to the first quintile (AHR: 1.75, 95% CI: 1.08-2.80).

Conclusion

Higher visit-to-visit BP variability are associated with rapid deterioration of renal function. Furthermore, there are different association between BP variability and renal outcome depending on arterial stiffness such that higher BP variability has a strong association with CKD progression among patients with high arterial stiffness.