Related Experiment Videos
Blood pressure variability and outcomes in chronic kidney disease
Biagio Di Iorio1, Andrea Pota, Maria Luisa Sirico
1Nephrology of Landolfi Hospital, Solofra AV, Italy. br.diiorio@gmail.com
Insights
Visit-to-visit systolic blood pressure variability (SBPV) increases mortality risk in chronic kidney disease (CKD) patients. This SBPV measure may aid in stratifying mortality risk for CKD patients not yet on dialysis.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- Chronic kidney disease (CKD) patients exhibit significant mortality risk.
- Systolic blood pressure variability (SBPV) is a potential risk factor in CKD.
- The impact of SBPV on mortality and dialysis initiation in non-dialysis CKD patients requires further investigation.
Purpose of the Study:
- To investigate the association between visit-to-visit SBPV and mortality in CKD patients.
- To examine the relationship between SBPV and the progression to dialysis in CKD patients.
- To explore the carry-over effect of SBPV on mortality after dialysis initiation.
Main Methods:
- A longitudinal retrospective, observational, multi-centre study was conducted.
- 374 elderly CKD patients (eGFR <60 mL/min/m(2)), free from cardiovascular disease, were included.
- SBPV was calculated as the ratio of standard deviation to mean systolic blood pressure over a 4-5 month period.
Main Results:
- A significant association was found between higher SBPV and increased all-cause mortality risk (HR 1.05 per 1% increase, P=0.001).
- No significant association was observed between SBPV and progression to dialysis.
- No deaths were recorded after the initiation of dialysis during the follow-up period.
Conclusions:
- Visit-to-visit SBPV is a significant predictor of mortality in CKD patients.
- SBPV may serve as a valuable tool for risk stratification in CKD management.
- Further research is warranted to explore the clinical utility of SBPV in CKD patients.
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/m(2), 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.