Non-Dipper Status and Left Ventricular Hypertrophy as Predictors of Incident Chronic Kidney Disease

Abstract

We have hypothesized that non-dipper status and left ventricular hypertrophy (LVH) are associated with the development of chronic kidney disease (CKD) in non-diabetic hypertensive patients. This study included 102 patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. Ambulatory blood pressure monitoring and echocardiography were performed at the beginning of the study, and the serum creatinine levels were followed. During the average follow-up period of 51 months, CKD developed in 11 patients. There was a significant difference in the incidence of CKD between dippers and non-dippers (5.0% vs 19.0%, P < 0.05). Compared to patients without CKD, patients with incident CKD had a higher urine albumin/creatinine ratio (52.3 ± 58.6 mg/g vs 17.8 ± 29.3 mg/g, P < 0.01), non-dipper status (72.7% vs 37.4%, P < 0.05), the presence of LVH (27.3% vs 5.5%, P < 0.05), and a lower serum HDL-cholesterol level (41.7 ± 8.3 mg/dL vs 50.4 ± 12.4 mg/dL, P < 0.05). Based on multivariate Cox regression analysis, non-dipper status and the presence of LVH were independent predictors of incident CKD. These findings suggest that non-dipper status and LVH may be the therapeutic targets for preventing the development of CKD in non-diabetic hypertensive patients.

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

“…As non-/reverse-dipping is considered a risk factor of cardiovascular events in non-CKD hypertensive patients, non-/reverse-dipping is considered a risk factor of CKD progression (2728). Non-/reverse-dipping was also shown to be a risk factor for cardiovascular events and correlated with markers for cardiovascular events in CKD patients (101415162829). Multiple factors cause suppressed nighttime BP decrease, such as older age, race, autonomic dysfunction, abnormal sleep-wake cycle, and sodium sensitivity (30).…”

Microalbuminuria is Independently Associated with Arterial Stiffness and Vascular Inflammation but not with Carotid Intima-Media Thickness in Patients with Newly Diagnosed Type 2 Diabetes or Essential Hypertension

“…Patients who manifested diabetes and hypertension simultaneously at the time of inclusion were also excluded. Other exclusion criteria were age < 18 or > 65 yr; evidence of clinically evident nephropathy (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 or overt proteinuria) (17); previous therapy for hypertension or diabetes; electrocardiographic or echocardiographic left ventricular hypertrophy (LVH); and positive history or clinical signs of atherosclerotic CVD, heart failure, infection, and neoplastic or inflammatory diseases.…”

Prospective analysis of the association of ambulatory blood pressure characteristics with incident chronic kidney disease

“…Although the association of 24-h ABPM characteristics with renal disease has been studied in patients with pre-existing CKD [8,[23][24][25], studies among those with normal renal function are small and retrospective [9,26,27], and none have examined African Americans -a population at increased risk of having both abnormalities in the diurnal BP pattern and renal disease [11,28,29]. In a retrospective study of 102 hypertensive Korean patients clinically referred for ABPM, nondippers had a substantially higher risk of developing CKD (hazard ratio 30.8, 95% CI 1.8-542.1) over roughly 4 years of follow-up [26]. However, only 11 individuals in that study developed CKD, which accounts for the unstable association.…”