Journal Article

Blood pressure variability and outcomes in chronic kidney disease

Biagio Di Iorio, Andrea Pota, Maria Luisa Sirico, Serena Torraca, Lucia Di Micco, Roberto Rubino, Pasquale Guastaferro and Antonio Bellasi

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 12, pages 4404-4410
Published in print December 2012 | ISSN: 0931-0509
Published online September 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs328
Blood pressure variability and outcomes in chronic kidney disease

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Background

We investigated the effects of visit-to-visit systolic blood pressure variability (SBPV) on both mortality and dialysis inception in a cohort of chronic kidney disease (CKD) patients not requiring dialysis therapy. Furthermore, we also explored the carry-over effect of visit-to-visit SBPV on mortality after dialysis initiation.

Methods

We conducted a longitudinal retrospective, observational, multi-centre study in three tertiary care nephrology outpatient clinics. All the ambulatory CKD patients admitted to the outpatient clinics from 1 January 2004 to 31 December 2005 were screened for study eligibility. We selected all consecutive patients older than 18 years of age with a mean estimated glomerular filtration rate of <60 mL/min/m2, free from cardiovascular disease. SBPV was defined as the ratio of the SD to the mean SBP of five values recorded during a run-in phase of 4–5 months. Data on dialysis inception and mortality were recorded through 31 December 2010.

Results

Overall, we selected a cohort of 374 elderly (median age: 79 years) subjects. A total of 232 (62%) and 103 (29%) patients were male and had diabetes, respectively. A significant association between SBPV and the risk of death but not of CKD progression to dialysis was noted at univariate and after multivariable adjustments (hazard ratio for all-cause mortality per 1% increase in SBPV: 1.05; 95% confidence interval: 1.02–1.09; P = 0.001). Notably, no lethal event was recorded after dialysis initiation.

Conclusions

Current findings suggest that SBPV may be of use for risk stratification in CKD patients.

Keywords: chronic kidney disease; death; dialysis inception; systolic blood pressure variability

Journal Article.  4083 words.  Illustrated.

Subjects: Nephrology

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