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. 2020 Mar 31;39(1):70-80.
doi: 10.23876/j.krcp.19.103.

Association of ambulatory blood pressure monitoring with renal outcome in patients with chronic kidney disease

Hyung Eun Son  1 , Ji Young Ryu  1 , Suryeong Go  1 , Youngjin Yi  1 , Kipyo Kim  2 , Yoon Kyu Oh  3   4 , Kook-Hwan Oh  5   4 , Ho Jun Chin  1   4
Affiliations

Association of ambulatory blood pressure monitoring with renal outcome in patients with chronic kidney disease

Hyung Eun Son et al. Kidney Res Clin Pract. .

Abstract

Background: The significance of ambulatory blood pressure (ABP) in Korean patients with chronic kidney disease (CKD) in relation to renal outcome or death remains unclear. We investigated the role of ABP in predicting end-stage renal disease or death in patients with CKD.

Methods: We enrolled 387 patients with hypertension and CKD who underwent ABP monitoring and were followed for 1 year. Data on clinical parameters and outcomes from August 2014 to May 2018 were retrospectively collected. The composite endpoint was end-stage renal disease or death. Patients were grouped according to the mean ABP.

Results: There were 66 endpoint events, 52 end-stage renal disease cases, and 15 mortalities. Among all patients, one developed end-stage renal disease and died. Mean ABP in the systolic and diastolic phases were risk factors for the development of composite outcome with hazard ratios of 1.03 (95% confidence interval [CI], 1.01-1.04; P < 0.001) and 1.04 (95% CI, 1.02-1.07; P = 0.001) for every 1 mmHg increase in BP, respectively. Patients with mean ABP between 125/75 and 130/80 mmHg had a 2.56-fold higher risk for the development of composite outcome (95% CI, 0.72-9.12; P = 0.147) as compared to those with mean ABP ≤ 125/75 mmHg. Patients with mean ABP ≥ 130/80 mmHg had a 4.79-fold higher risk (95% CI, 1.68-13.70; P = 0.003) compared to those with mean ABP ≤ 125/75 mmHg. Office blood pressure (OBP) was not a risk factor for the composite outcome when adjusted for covariates.

Conclusion: In contrast to OBP, ABP was a significant risk factor for end-stage renal disease or death in CKD patients.

Keywords: Blood pressure monitoring; Hypertension; Kidney failure; ambulatory; chronic.

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Conflict of interest statement

Conflicts of interest

All authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Diagram of the study population and collection of the composite outcome.
ABPM, ambulatory blood pressure monitoring; EMR, electronic medical record; ESRD, end-stage renal disease; KSN, Korean Society of Nephrology.
Figure 2
Figure 2. Relationships between office blood pressure (BP) and mean ambulatory blood pressure in the (A) systolic and (B) diastolic phase.
ABP, ambulatory BP; DBP, diastolic BP; HTN, hypertension; SBP, systolic BP.
Figure 3
Figure 3. The proportion of patients free from the composite outcome (A) or risk of end-stage renal disease (ESRD) (B) stratified by mean ambulatory blood pressures (ABPs).
See this image and copyright information in PMC

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