Lowest nocturnal systolic blood pressure is related to heavy proteinuria and outcomes in elderly patients with chronic kidney disease

Guo, Xinru; Liang, Shuang; Wang, Wenling; Zheng, Ying; Zhang, Chun; Chen, Xiangmei; Cai, Guangyan

doi:10.1038/s41598-021-85071-2

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…28 A multicenter cohort study of 356 older Chinese patients with CKD showed that proteinuria and kidney progression was associated with the lowest level of nighttime BP. 29 In a crosssectional analysis among 2386 patients with nondialysis CKD, patients with isolated nighttime hypertension had higher odds of target organ damage, including LVH, abnormal carotid intima-media thickness, low eGFR, and albuminuria. 28 Diagnosis of nighttime hypertension relies on ABPM, meaning that nighttime hypertension may often be masked by normal office BP measurements.…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies in general populations and patients with hypertension and CKD showed that elevated nighttime BP was associated with target organ damage . A multicenter cohort study of 356 older Chinese patients with CKD showed that proteinuria and kidney progression was associated with the lowest level of nighttime BP . In a cross-sectional analysis among 2386 patients with nondialysis CKD, patients with isolated nighttime hypertension had higher odds of target organ damage, including LVH, abnormal carotid intima-media thickness, low eGFR, and albuminuria …”

Section: Discussionmentioning

confidence: 99%

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Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

Ren

Xie

et al. 2022

JAMA Netw Open

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IMPORTANCE Nighttime hypertension is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD), but nighttime hypertension, a subtype of masked uncontrolled hypertension (MUCH), is often undetected among patients with controlled office blood pressure. Little attention has been paid to patients with CKD and nighttime MUCH. OBJECTIVETo investigate the prevalence of nighttime MUCH and its associations with cardiovascular and kidney outcomes in patients with CKD who were not receiving dialysis. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included patients with nondialysis CKD and hypertension, enrolled in Shanghai, China, from July 2012 through November 2020 and followed up for a median of 39 months. EXPOSURESParticipants were classified as having controlled hypertension, sustained hypertension, and MUCH, which was further divided into isolated nighttime MUCH and day-night MUCH, assessed by office and ambulatory blood pressure monitoring. MAIN OUTCOMES AND MEASURES Left ventricular hypertrophy (LVH) was determined by echocardiography. The composite kidney outcome consisted of end-stage kidney diseases (ESKD) and a reduction of estimated glomerular filtration rate (eGFR) by 50% or more. Logistic and Cox regression assessed the associations of hypertension subtypes with LVH and kidney outcomes. RESULTS The 675 patients (425 [63.0%] men; mean [SD] age, 50.8 [15.9] years; mean [SD] eGFR, 61.6 [29.4] mL/min/1.73 m 2 ) included 125 (19.3%) with controlled hypertension, 244 (37.6%) with MUCH, and 280 (43.1%) sustained hypertension. Among patients with MUCH, 2 (0.8%) had isolated daytime MUCH, 154 (63.1%) had isolated nighttime MUCH, and 88 (36.1%) had day-night MUCH.During a median (IQR) follow-up of 39 (19-64) months, 130 composite kidney events, including 97 ESKD events, occurred. Compared with controlled hypertension, MUCH and sustained hypertension were associated with LVH (eg, MUCH: odds ratio [OR], 2.94; 95% CI, 1.18-7.34; P = .02) and the composite kidney outcome (eg, MUCH: hazard ratio [HR], 4.12; 95% CI, 1.75-9.73; P = .001) after adjustment for age, sex, proteinuria, eGFR, and other baseline risk factors. Multivariate-adjusted associations were also significant between day-night MUCH and LVH (OR, 3.26; 95% CI, and between isolated nighttime MUCH and the composite kidney outcome (HR, 4.27; 95% CI, 1.69-10.77). CONCLUSIONS AND RELEVANCEIn this cohort study, nighttime MUCH was common and associated with LVH and poor kidney outcomes among patients with hypertension and nondialysis CKD. These findings suggest that ambulatory blood pressure monitoring was inadequately used in (continued) Key Points Question Is nighttime masked uncontrolled hypertension (MUCH) in patients with chronic kidney disease (CKD) not receiving dialysis associated with worse cardiovascular and kidney outcomes? Findings In this cohort study of 675 patients with hypertension and nondialysis CKD, approximately one-third of patients had nighttime MUCH, consisting of 13.0% day-night MUCH and 22.8...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

Ren

Xie

et al. 2022

JAMA Netw Open

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“…CKD results from diverse causes and is characterized by the progressive and irreversible loss of renal function, taking up about 11%-16% of the global population [25,26]. Numerous basic and animal articles have verifed that MRAs are capable of signifcantly suppressing the activity of proinfammatory cytokines and pro-oxidants, improving the antiinfammatory response of kidney tissue, improving renal ischemia, mitigating collagen deposition, and preventing renal fbrosis [2,27,28].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Eplerenone for Treating Chronic Kidney Disease: A Meta-Analysis

Cao

Sun

et al. 2023

International Journal of Hypertension

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Background. In recent years, a large amount of clinical evidence and animal experiments have demonstrated the unique advantages of mineralocorticoid receptor antagonists (MRA) for treating chronic kidney disease (CKD). Aims. Accordingly, the present study aimed to systematically assess the second-generation selective MRAs eplerenone’s safety and effectiveness for treating CKD. Methods. Four databases (PubMed, The Cochrane Library, Embase, and Web of Science) were searched for randomized controlled trials (RCT) correlated with eplerenone for treating CKD up to September 21, 2022. By complying with the inclusion and exclusion criteria, literature screening, and data extraction were conducted. Results. A total of 19 randomized controlled articles involving 4501 cases were covered. As suggested from the meta-analysis, significant differences were reported with the 24-h urine protein (MD = −42.23, 95% confidence interval [CI] = -76.72 to −7.73, P = 0.02), urinary albumin-creatinine ratio (UACR) (MD = −23.57, 95% CI = −29.28 to −17.86, P < 0.00001), the systolic blood pressure (SBP) (MD = −2.73, 95% CI = −4.86 to −0.59, P = 0.01), and eGFR (MD = −1.56, 95% CI = −2.78 to −0.34, P = 0.01) in the subgroup of eplerenone vs placebo. The subgroups of eplerenone vs placebo (MD = 0.13, 95% CI = 0.07 to 0.18, P < 0.00001) and eplerenone vs thiazide diuretic (MD = 0.18, 95% CI = 0.13 to 0.23, P < 0.00001) showed the significantly increased potassium levels. However, no statistical significance was reported between the eplerenone treatment groups and the control in the effect exerted by serum creatinine (MD=0.03, 95% CI = −0.01 to 0.07, P = 0.12) and diastolic blood pressure (DBP) (MD = 0.11, 95% CI = −0.41 to 0.63, P = 0.68). Furthermore, significant risks of hyperkalemia were reported in the eplerenone group (K+ ≥ 5.5 mmol/l, RR = 1.70, 95%CI = 1.35 to 2.13, P =< 0.00001; K+ ≥ 6.0 mmol/l, RR = 1.61, 95% CIs = 1.06 to 2.44, P = 0.02), respectively. Conclusions. Eplerenone has beneficial effects on CKD by reducing urinary protein and the systolic blood pressure, but it also elevates the risk of hyperkalemia.

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“…20,21 Some have demonstrated that absolute nocturnal BP is more important than dipping status. 22,23 Hermida has repeatedly shown that adults with isolated nocturnal hypertension have a higher risk of CKD progression than those with isolated daytime hypertension. 24 Interestingly, this effect was not observed in our population.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Hypertension in Children With Chronic Kidney Disease Is Common and Associated With Progression to Kidney Replacement Therapy

Guzman-Limon

Jiang

et al. 2022

Hypertension

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BACKGROUND: Nocturnal hypertension is a risk factor for chronic kidney disease (CKD) progression among adults. In children, effects of nocturnal hypertension on CKD progression is less studied. METHODS: We investigated the relationships between nocturnal, daytime, or sustained hypertension and progression to kidney replacement therapy in children using Cox proportional hazards models. Nocturnal and diurnal hypertension respectively defined as: mean blood pressure >95th percentile and/or load >25% for either systolic or diastolic blood pressure within sleep or wake periods. RESULTS: One thousand five hundred seventy-seven ambulatory blood pressure monitoring studies from 701 CKiD participants were reviewed. Nighttime, daytime, and both types of hypertension were 19%, 7%, and 33%, respectively. Participants with both daytime and nocturnal hypertension had the highest risk of kidney replacement therapy. Among children with CKD, compared with those who were normotensive, those with isolated nocturnal hypertension had a hazard ratio of 1.49 ([CI, 0.97–2.28]; P =0.068) while those with both daytime and nocturnal hypertension had a HR of 2.23 ([CI, 1.60–3.11]; P <0.001) when adjusted for age, race, sex, and baseline proteinuria and glomerular filtration. Estimates for risk were similar among glomerular and nonglomerular participants but not significant in glomerular due to smaller sample size. CONCLUSIONS: The presence of both daytime and nocturnal hypertension is significantly associated with risk of kidney replacement therapy. Our study confirms the utility of ambulatory blood pressure monitoring in children with CKD. Identifying and controlling both daytime and nocturnal hypertension using ambulatory blood pressure monitoring may improve outcomes and delay CKD progression in this population.

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Lowest nocturnal systolic blood pressure is related to heavy proteinuria and outcomes in elderly patients with chronic kidney disease

Cited by 5 publications

References 40 publications

Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

Efficacy and Safety of Eplerenone for Treating Chronic Kidney Disease: A Meta-Analysis

Nocturnal Hypertension in Children With Chronic Kidney Disease Is Common and Associated With Progression to Kidney Replacement Therapy

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