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Riser pattern is a predictor of kidney mortality among patients with chronic kidney disease

Kentaro Nakai1, Hideki Fujii1, Kentaro Watanabe1

  • 1a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.

Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|July 2, 2016
PubMed

Insights

In chronic kidney disease (CKD) patients, a rising blood pressure (BP) pattern overnight, known as the riser pattern, is linked to worse kidney survival. This risk is amplified in patients with elevated brain natriuretic peptide (BNP) levels.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • Hypertension is a major risk factor for cardiovascular mortality and loss of kidney function.
  • The absence of a normal nocturnal blood pressure (BP) decline indicates poor prognosis.
  • Characteristics of hypertension in moderate-to-severe chronic kidney disease (CKD) require further evaluation.

Purpose of the Study:

  • To assess the circadian variation of BP in CKD patients.
  • To evaluate the impact of BP circadian rhythm on kidney survival.
  • To determine the role of brain natriuretic peptide (BNP) in kidney prognosis.

Main Methods:

  • 124 patients with moderate-to-severe CKD (eGFR <45 ml/min/1.73 m²) were enrolled.
  • 24-hour ambulatory BP monitoring (ABPM) was used to assess BP circadian patterns.
  • The association between BP patterns, BNP levels, and kidney survival was analyzed.

Main Results:

  • 45% of patients exhibited a non-dipper BP pattern, 35% a riser pattern, and 19% a dipper pattern.
  • The riser-pattern group had higher prevalence of diabetes, elevated BNP, and lower eGFR compared to non-risers.
  • Kidney survival was significantly worse in the riser-pattern group, especially those with higher BNP levels.

Conclusions:

  • The riser BP pattern is common in CKD and associated with increased risk for kidney survival.
  • CKD patients with a riser BP pattern and elevated BNP levels face a poorer kidney prognosis.
  • Circadian BP variations, particularly the riser pattern, are critical markers for kidney health in CKD.
Abstract

Keywords:
Ambulatory blood pressure monitoringbrain natriuretic peptidediabeteshypertensionkidney survival

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