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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

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Blood pressure load associated with progressive kidney function decline in biopsy-proven atherosclerotic chronic

Hiroki Nobayashi1, Go Kanzaki2, Haruki Mae1

  • 1Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.

Clinical and Experimental Nephrology
|August 4, 2025
PubMed

Insights

Elevated blood pressure (BP) load, even with normal office BP readings, significantly accelerates chronic kidney disease (CKD) progression. Comprehensive 24-hour ambulatory BP monitoring (ABPM) is vital for managing CKD patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Hypertension Research

Background:

  • Hypertension is a primary driver of chronic kidney disease (CKD) progression.
  • The specific impact of elevated blood pressure (BP) load, particularly when office BP readings are normal, remains insufficiently understood.
  • This study investigates the influence of elevated BP load in biopsy-proven CKD patients with normal office BP.

Purpose of the Study:

  • To determine the impact of elevated blood pressure (BP) load in patients with biopsy-proven chronic kidney disease (CKD) and normal office BP.
  • To compare outcomes between patients with isolated BP load elevation, hypertension, and normotension.
  • To identify BP load elevation as a risk factor for CKD progression.

Main Methods:

  • Retrospective cohort study involving 57 patients with histologically confirmed atherosclerotic CKD.
  • Utilized 24-hour ambulatory BP monitoring (ABPM) and kidney biopsy data.
  • Classified patients into normotension, isolated BP load elevation, and hypertension groups.

Main Results:

  • Patients with isolated BP load elevation and hypertension exhibited significantly higher rates of adverse kidney events compared to the normotension group (p < 0.01).
  • After adjusting for confounding factors, isolated BP load elevation remained a significant predictor of adverse kidney outcomes (hazard ratio, 9.25).
  • A sustained decline in estimated glomerular filtration rate (eGFR) of ≥30% within 3 years was the primary outcome measure.

Conclusions:

  • Isolated BP load elevation is a significant risk factor for CKD progression, even when office BP is normal.
  • Targeting BP load normalization may offer a therapeutic strategy for managing CKD.
  • 24-hour ABPM is essential for comprehensive CKD assessment, revealing abnormalities missed by conventional BP measurements.
Abstract

Keywords:
Ambulatory blood pressure monitoringArteriosclerosisBlood pressure loadChronic kidney diseaseHypertensionKidney biopsy

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