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

Nakano, Chikara; Morimoto, Satoshi; Nakahigashi, Mitsutaka; Kusabe, Makiko; Ueda, Hiroko; Someya, Kazunori; Ichihara, Atsuhiro; Iwasaka, Toshiji; Shiojima, Ichiro

doi:10.1038/hr.2014.163

Cited by 17 publications

(9 citation statements)

References 31 publications

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“…Yilmaz et al studied 406 patients with nondiabetic CKD and found a significant positive correlation between FMD and eGFR [18]. Similar results have also been noted by others [27–29]. Although these studies used FMD to evaluate endothelial function, very few studies have explored the relationship between PAT-derived RHI and renal function in the CKD population.…”

Section: Discussionmentioning

confidence: 53%

Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease

Wang

Huang

et al. 2019

BMC Nephrol

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Background The reactive hyperemia index (RHI), measured by peripheral arterial tonometry (PAT), is a novel measurement of endothelial function and has been proven to be valuable in cardiovascular risk stratification in several populations. The current study aims to explore its relation to renal function and its association with traditional cardiovascular risk factors in patients with chronic kidney disease (CKD). Methods Subjects with non-dialysis dependent CKD were recruited and 252 of them had a successful PAT test. In addition to general demographic and medical information, carotid-femoral pulse wave velocity (cfPWV), carotid-radial pulse wave velocity (crPWV) and augmentation index (AIx) were recorded. Results The mean age of the study population was 57.7 (±14.7) years and 155 (61.5%) were males. The average RHI was 1.92 (±14.7) with no difference noted between males and females. There was no statistically significant correlation between RHI and eGFR (r = − 0.107, p = 0.089) or urine protein-to-creatinine ratio (r = 0.036, p = 0.570). With adjustment for age and sex, RHI was associated with systolic blood pressure (BP) (β = 0.006, p = 0.001), diastolic BP (β = 0.008, p = 0.010), heart rate (β = − 0.007, p = 0.015) crPWV (β = 0.037, p = 0.022) and AIx (β = 0.006, p = 0.001), but not with cfPWV or any other conventional risk factors analyzed. Systolic BP remained the only predictor for RHI in the stepwise regression analysis. Conclusions RHI did not decline with reduced renal function in CKD patients and had a modest association with traditional cardiovascular risk factors. Further studies are warranted to determine if RHI could predict cardiovascular outcome in CKD patients.

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Section: Discussionmentioning

confidence: 53%

Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease

Wang

Huang

et al. 2019

BMC Nephrol

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“…BPV may have an even greater significance among patients on HD because of the high prevalence of comorbidities in such patients, including diabetes mellitus, cardiovascular diseases, dialysis‐related factors (e.g., rapid fluid and osmolar shifts during HD), and dialyzability of antihypertensive medications, all of which may cause BP fluctuations in these patients . In fact, a few recent studies have shown that renal dysfunction is associated with higher BPV . In addition, several studies have been conducted concerning the association of BPV with clinical outcomes in patients on HD.…”

Section: Discussionmentioning

confidence: 99%

“…20 In fact, a few recent studies have shown that renal dysfunction is associated with higher BPV. 21,22 In addition, several studies have been conducted concerning the association of BPV with clinical outcomes in patients on HD. Flythe et al reported the association between intradialytic BPV and all-cause and cardiovascular mortality in a cohort of 6393 HD patients.…”

Section: Discussionmentioning

confidence: 99%

A relationship of intradialytic blood pressure variability with vascular access outcomes in patients on hemodialysis

Kim

Seo

Kim

et al. 2019

Hemodialysis International

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Introduction: Vascular access dysfunction is a major cause of morbidity in patients with end‐stage renal disease (ESRD) on hemodialysis (HD). Thus, identifying risk factors for vascular access failure is important. Patients on HD are routinely exposed to high blood pressure variability (BPV) during HD. However, the impact of intradialytic BPV on vascular access outcomes is unknown. Therefore, we investigated the association of intradialytic BPV with vascular access outcomes in patients on HD. Methods: One hundred and thirty patients with ESRD who created vascular access for HD were evaluated. We examined 12 dialysis sessions per patient and recorded BP five times for each session. BPV was assessed using residual standard deviation derived from the linear regression model. The patients were divided into two groups according to a level below or above the median value of intradialytic BPV and compared. The primary outcome was primary unassisted vascular access patency. Findings: The median time to loss of primary unassisted patency was significantly longer in low intradialytic BPV group than in high intradialytic BPV group (52 months vs. 21 months, P < 0.001) during the mean follow‐up of 3.7 years. After adjustment for other variables, high intradialytic BPV was significantly associated with loss of primary unassisted vascular access patency (hazard ratio, 2.605; 95% confidence interval, 1.462–4.643; P = 0.001). Discussion: Our study revealed a significant correlation between intradialytic BPV and vascular access patency. Further studies are needed to identify methods for lowering BPV.

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“…Nakano et al reported that eGFR is associated with vvBPV abnormalities in patients with chronic kidney disease. 11 In the present study, factors known to be associated with vvBPV (age, sex, BMI, diabetes mellitus, and CCB) and PWV were added as covariates for analysis. 6,8-12, 14 In addition, subjects with eGFR <60 ml/min/1.73 m 2 were excluded.…”

Section: Resultsmentioning

confidence: 99%

Obstructive Sleep Apnea as Possible Causal Factor for Visit-to-Visit Blood Pressure Variability

Shiina

Tomiyama

Takata

et al. 2016

Circ J

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Background: Recent studies have shown that visit-to-visit blood pressure variability (BPV) is an independent risk factor for cardiovascular disease. However, it has not been clarified whether obstructive sleep apnea (OSA) is associated with visit-to-visit BPV. Methods and Results:The 56 subjects with OSA and 26 control subjects without OSA were examined. Office BP was measured on 5 separate consecutive occasions prior to a polysomnography examination. The visit-to-visit BPV was expressed as the standard deviation and the coefficient of variation of the 5 systolic BP measurements. In subjects with an apnea-hypopnea index (AHI) of more than 20 episodes per hour, the visit-to-visit BPV was also measured after the start of continuous positive airway pressure (CPAP) therapy. Overall, the AHI positively correlated with the standard deviation and the coefficient of variation of systolic BP. In a multivariate analysis, the plasma noradrenaline level and the AHI were independently and positively correlated with the standard deviation and the coefficient of variation of the systolic BP. Among the patients who underwent CPAP therapy, good adherence with CPAP therapy significantly reduced the visit-to-visit BPV. Conclusions:OSA is associated with abnormal visit-to-visit BPV and sympathetic activation seems to be related in some way. (Circ J 2016; 80: 1787 -1794

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

Cited by 17 publications

References 31 publications

Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease

Digital microvascular reactivity does not decline with impaired renal function in chronic kidney disease

A relationship of intradialytic blood pressure variability with vascular access outcomes in patients on hemodialysis

Obstructive Sleep Apnea as Possible Causal Factor for Visit-to-Visit Blood Pressure Variability

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