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Kidney Week

Abstract: PO1768

Nondipping Heart Rate in Patients with CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Oba, Rina, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Kanzaki, Go, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Haruhara, Kotaro, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Sasaki, Takaya, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Okabayashi, Yusuke, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Koike, Kentaro, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Tsuboi, Nobuo, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  • Yokoo, Takashi, Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
Background

A decrease in the nocturnal heart rate (HR) decline, nondipping HR (NHR), was reported to be 14% in the general population and related to cardiovascular events and all-cause mortality, however, the clinicopathologic features of chronic kidney disease (CKD) patients with NHR is still unclear. Previous studies have reported that interstitial and/or tubular atrophy (IF/TA) was significantly associated with both daytime and nighttime hypertension observed with ambulatory blood pressure monitoring (ABPM). We aimed to investigate the clinicopathologic findings associated with NHR status in patients with CKD.

Methods

We retrospectively identified 135 subjects who underwent ABPM and kidney biopsy simultaneously at our institution, from 2016 to 2019. We excluded patients with age <20 years, end-stage kidney disease, less than 5 glomeruli in the kidney biopsy, and patients taking β-blockers. NHR status was defined as (daytime HR − nighttime HR)/daytime HR <0.1. The percentage of global glomerulosclerosis (GS%), IF/TA, and the severity of arteriosclerosis were scored semi-quantitatively according to the Mayo Clinic/Renal Pathology Society Chronicity Score (CS).

Results

The median age was 51 years [interquartile range: 35–63], 54.0% of which were male, and the median eGFR was 53.0 [30.0–75.0] mL/min/1.73m2. NHR status was found in 39 out of 135 patients (28.9%). Patients with NHR were older and had worse renal function, higher blood pressure, lower hemoglobin level, and a larger amount of urinary protein excretion than patients with dipping HR. In terms of histopathological parameters, patients with NHR had more severe GS%, IF/TA, arteriosclerosis, and higher CS (Table 1). In multivariable analysis, GS% was established as an independent determinant of NHR status after its adjustment according to age, sex, and other statistically significant parameters (β = 1.03 [1.00–1.05], P = 0.02).

Conclusion

NHR status was observed in 28.9% of CKD patients. This study indicates that GS% is the most relevant histopathological parameter associated with NHR in this population.