ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-OR49

Fluid Overload, 24-Hour Blood Pressure Patterns, and Their Association with Cardiovascular and Kidney Outcomes in CKD

Session Information

Category: Hypertension and CVD

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


  • Ko, Ye Eun, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  • Jhee, Jong Hyun, Gangnam Severance Hospital, Gangnam-gu, Seoul, Korea (the Republic of)
  • Yoo, Tae-Hyun, Yonsei University Institute of Kidney Disease, Seodaemun-gu, Seoul, Korea (the Republic of)

Fluid overload is well-known risk factor for adverse cardiovascular and kidney outcomes in chronic kidney disease (CKD) patients. However, it is unclear whether fluid overload is associated with blood pressure (BP) patterns and their relationship to adverse clinical outcomes in CKD patients.


A total of 1,147 CKD (stage 1 to 5) patients were enrolled from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk). The patients were classified into tertile based on fluid status defined as the extracellular water to total body water ratio (ECW/TBW) measured by bioelectrical impedance analysis; hypovolemic, euvolemic, and hypervolemic groups. BP patterns were assessed by 24-h BP measurements; dipper (nighttime BP fall 10-20%), extreme dipper (nighttime BP fall >20%), non-dipper (nighttime BP fall 0-10%), and reverse dipper (nighttime BP fall <0%). Primary outcome was composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. The secondary outcome was progression of CKD (composite of at least 50% decrease in eGFR> 50% from baseline or eGFR <60 ml/min/1.73 m2, or end-stage kidney disease).


The mean age of study subjects was 59.9±12.2 years and 615(53.6%) were male. The hypervolemic group was associated with increased risk of reverse-dipping pattern (OR, 2.46; 95% CI, 1.30-4.64; P=0.01). During a median follow-up of 42.1 (41.3-42.9) months, the composite of cardiovascular events and CKD progression occurred in 42 (3.7%) and 345 (30.1%), respectively. The Kaplan-Meier analysis showed that hypervolemic group was associated with increased risk of cardiovascular events and CKD progression compared to hypovolemic group. In multivariable Cox analyses, hypervolemic group was associated with increased risk of cardiovascular events (HR, 4.44; 95% CI, 1.16-17.0; P=0.03). Moreover, hypervolemic group was associated with increased risk of CKD progression (HR, 2.47; 95% CI, 1.77-3.45; P<0.001). This increased risks of cardiovascular events and CKD progression with hypervolemic status were still consistent in patients with reverse-dipping pattern.


The increased risk of cardiovascular events and kidney disease progression in CKD patients with fluid overload can be explained by an association with a reverse-dipping BP pattern.