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Updated: Jan 28, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Long-term blood pressure variability and development of chronic kidney disease in type 2 diabetes
Francesca Viazzi1, Barbara Bonino1, Antonio Mirijello2
1Università degli Studi and Policlinico San Martino-IST, Genova.
Insights
High blood pressure variability predicts chronic kidney disease (CKD) in patients with type 2 diabetes and hypertension. This finding highlights the importance of monitoring blood pressure fluctuations for kidney health in this population.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Long-term visit-to-visit systolic blood pressure variability (SBP VVV) is a known predictor of cardiovascular events and end-stage renal disease in chronic kidney disease (CKD) patients.
- The role of SBP VVV in the development of CKD in patients with diabetes remains uncertain.
Purpose of the Study:
- To assess the predictive role of SBP VVV on the development of CKD in patients with type 2 diabetes (T2D) and hypertension in a real-world setting.
Main Methods:
- Analysis of clinical records from 30,851 patients with T2D and hypertension over a 4-year follow-up period.
- SBP variability measured using coefficient of variation, SD of mean SBP, and average absolute difference of successive values.
- CKD defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² and/or eGFR reduction ≥ 30% from baseline.
Main Results:
- Over 4 years, 9.7% of patients developed eGFR < 60 and 4.5% had an eGFR reduction ≥ 30%.
- Higher SBP VVV, particularly in the upper quintiles, was associated with an increased risk of developing both components of CKD.
- Multivariable adjusted odds ratios for CKD incidence increased incrementally with higher SBP coefficient of variation quintiles.
Conclusions:
- Increased long-term SBP variability is a significant predictor of CKD development in patients with type 2 diabetes and hypertension.
- Monitoring SBP variability may be crucial for identifying individuals at higher risk of kidney disease progression in this population.
Objective:
Long-term visit-to-visit SBP variability (VVV) has been shown to predict cerebro-cardiovascular events and end-stage renal disease in chronic kidney disease (CKD) patients. Whether SBP VVV is also a predictor of CKD development in diabetes is currently uncertain. We assessed the role of SBP VVV on the development of CKD in patients with type 2 diabetes (T2D) and hypertension in real life.
Methods:
Clinical records from 30 851 patients with T2D and hypertension, with normal estimated glomerular filtration rate (eGFR) and regular visits during a 4-year follow-up were analyzed. SBP variability was measured by three metrics: coefficient of variation; SD of the mean SBP and average absolute difference of successive values in each individual. CKD was defined as eGFR less than 60 and/or a reduction in eGFR at least 30% from baseline.
Results:
Over the 4-year follow-up, 9.7% developed eGFR less than 60 and 4.5% an eGFR reduction at least 30% from baseline. Several clinical characteristics (older age, male sex, SBP, DBP, albuminuria, glycated hemoglobin, insulin treatment) were related to intraindividual SBP variability. Patients with VVV in the upper quintile showed an increased risk of developing both components of CKD [adjusted odds ratio (OR) 1.21, P < 0.001 and 1.32, P < 0.001, respectively]. The multivariable adjusted ORs of SBP coefficient of variation quintiles 2-5 for the incidence of CKD were incrementally higher (OR 1.04, P = 0.601, OR 1.05, P = 0.520, OR 1.21, P < 0.017 and OR 1.42, P < 0.001 as compared with the first quintile).
Conclusion:
Increased long-term BP variability predicts CKD in patients with T2D and hypertension.
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