Analysis Of Influencing Factors And Prognosis Of Blood Pressure Variability In Patients With Chronic Kidney Disease

Objective:To investigate the blood pressure variability(BPV)of non-dialysis chronic kidney patients and to explore the risk factors of increased BPV and their relationship with renal prognosis and cardiovascular and cerebrovascular events.Methods:This is a retrospective cohort study.Patients with non-dialysis chronic kidney disease who have been diagnosed in the Department of Nephrology of the General Hospital of Ningxia Medical University from January 1,2012 to December 31,2018 and completed ambulatory blood pressure monitoring,and have been followed up regularly for more than 1 year.The quantitative indexes of BPV was variation independent of mean(VIM).The follow-up deadline was January 15,2020.In this study,serum creatinine doubling,renal replacement therapy,acute cardio-cerebral vascular events,and death were used as study endpoints.We divided into two groups based on the median 24-hour systolic VIM and the presence or absence of endpoint events,compared demographic data,laboratory indicators,and cardiac color Doppler ultrasound results between the two groups,and analyzed the risk factors for increased BPV.Multivariate COX regression and Kaplan-Meier survival analysis were used to understand the relationship between BPV and renal prognosis and cardiovascular and cerebrovascular events in non-dialysis CKD patients.Results: 1.This study included 245 patients with stage CKD1-4,with an average age of 42.07 ± 12.66 years,including 141 males(57.55%),135 patients with hypertension(55.1%),and 31 patients with diabetes(12.65%).The main primary diseases included primary glomerular disease(86.53%),diabetic nephropathy(5.31%)and hypertensive nephropathy(4.08%).2.Grouping according to the median 24-hour systolic blood pressure VIM showed that the BPV-increased group had a higher age and BMI,a higher proportion of hypertension and diabetes,serum potassium,serum uric acid,24-hour proteinuria,ventricular septal thickness,and left ventricular posterior wall thickness,Left ventricular end-diastolic diameter,left ventricular mass,and left ventricular mass fraction all significantly increased,and the differences were statistically significant.(P<0.05).Multivariate Logistic regression analysis found that higher BMI(OR 1.110,95% CI 1.019-1.209,P= 0.017),higher blood potassium(OR 2.227,95% CI 1.038-4.777,P= 0.040),higher left ventricular end diastolic diameter(OR 1.103,95% CI 1.023-1.189,P= 0.010)and combined hypertension(OR 2.525,95% CI 1.420-4.491,P= 0.002)were independent risk factors for increased BPV.3.Kaplan-Meier survival analysis: Renal and cardio-cerebral prognosis in patients with non-higher VIM group were significantly better than higher VIM group(log rank=7.444,P=0.006;log rank= 10.03,P= 0.002)4.Multivariate COX regression model analysis: after adjusted for age,gender,and traditional ESRD-related risk factors,we found that combined with diabetes(HR 3.802 95% CI 1.429-10.115 P= 0.007)and higher 24-hour mean systolic blood pressure(HR 1.034 95% CI 1.013-1.056 P= 0.001)as independent risk factors for renal outcomes in non-dialysis CKD patients,higher eGFR(HR 0.969 95% CI 0.954-0.984 P<0.001)and albumin(HR 0.918 95% CI 0.878-0.959 P<0.001)were protective factors.However,the independent risk factors of cardiovascular and cerebrovascular events were older age(HR 1.049,95% CI 1.007-1.092,P= 0.02),higher CV(HR 3.202,95% CI 1.030-9.959,P= 0.044),VIM(HR 4.662,95% CI 1.322-16.437,P= 0.017),and 24 h proteinuria(HR 1.273,95% CI 1.031-1.571,P= 0.025)in patients with non-dialysis CKD.Conclusion:1.55.1% of non-dialysis CKD patients have hypertension,and the risk factors for increased blood pressure variability are higher body mass index,hypertension,blood potassium,and larger left ventricular end-diastolic diameter.2.Increased blood pressure variability in non-dialysis CKD patients leads to poor kidney prognosis and is more prone to cardiovascular and cerebrovascular diseases.3.Higher Age,CV,VIM and 24 h urinary protein are independent risk factors for cardiovascular and cerebrovascular events in patients with non-dialysis CKD.4.Combining diabetes and higher 24-hour mean systolic blood pressure are independent risk factors for renal prognosis in non-dialysis CKD patients,eGFR and albumin are protective factors.