Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney disease

Abstract

An association between visit-to-visit variability (VVV) of blood pressure (BP) and renal damage was recently reported in a cross-sectional study. We aimed to clarify the longitudinal effect of VVV of BP on deterioration of renal function in patients with non-diabetic chronic kidney disease (CKD). We retrospectively studied 56 patients with non-diabetic CKD (stage 3 or 4) who visited our nephrology clinic between September 1994 and May 2011. VVV of BP was defined as the standard deviation and coefficient of variation (CV) of office BP measured at 12 consecutive visits. Main outcomes were the annual decline in the estimated glomerular filtration rate (eGFR) and the composite renal end point defined as a doubling of serum creatinine or the need for dialysis. The median observation period was 83 months. Standard deviation and CV of office systolic BP (SBP) were significantly associated with the slope of the eGFR after adjustments for confounders. The adjusted risk for composite renal end points more than doubled for each increment of 1-standard deviation of the standard deviation of office SBP (hazard ratio (HR) 2.20, P=0.001), and for each increment of 1-standard deviation of the CV of office SBP (HR 2.12, P=0.002). The present study demonstrated that the visit-to-visit variability of BP is an independent determinant of deterioration of renal function in patients with non-diabetic CKD.

The relationships between visit-to-visit blood pressure variability and renal and endothelial function in chronic kidney disease

“…Similarly, Yokota et al 16 reported that visit-to-visit BPV correlated significantly with the annual decline of eGFR in patients with non-diabetic CKD. Our data are in accordance with these findings as we showed indices of visit-to-visit BPV correlated negatively with eGFR, independent of age, HbA1c, LDL cholesterol, uric acid and M SBP in patients with CKD (Table 3).…”

“…High visit-to-visit BPV [14][15][16] and endothelial dysfunction 17 have been reported in CKD patients. This suggests that there may be an association between these two factors in these patients.…”

Visit-to-Visit Variability of BP and CKD Outcomes

“…In some but not all studies, persons with higher BP variability had more rapid CKD progression as measured by declines in eGFR or increases in urinary albumin (9)(10)(11)(12)(13). Some studies of persons with diabetes have shown an association of BP variability with more clinically impactful renal outcomes, including ESRD (10,14), but such an association has not been shown among persons without diabetes.…”

“…To calculate VVV of BP, we used data from seven followup visits that occurred 6,9,12,16,20,24, and 28 months after randomization. We started at the 6-month follow-up visit to avoid potential confounding by BP changes that occurred between randomization and that visit (mean BP fell by approximately 8/5 mmHg).…”

e impact of visit-to-visit systolic blood pressure variability on residual renal function and le ventricular hypertrophy in peritoneal dialysis patients

“…Yokota et al reported that visit-to-visit BP variability was associated with renal function decline in nondiabetic chronic kidney disease (21). Therefore, the aim of the present study was to investigate the relationships between visit-to-visit BP variability, RRF, and cardiovascular status in continuous ambulatory PD (CAPD) patients.…”