Reverse-dipping blood pressure pattern explains risks in patients with CKD, fluid overload
Patients with chronic kidney disease and fluid overload are at risk for cardiovascular events and kidney disease progression due to an association with a reverse-dipping blood pressure pattern, according to a speaker at ASN Kidney Week.
“Fluid overload can lead to adverse cardiovascular and renal outcomes,” Ye Eun Ko, MD, of the department of internal medicine at Yonsel University College of Medicine in Seoul, South Korea, said. “The aim of this study is to evaluate the association between volume overload and 24-hour blood pressure (BP) pattern, which are known risk factors for cardiovascular events and progression of kidney disease.”
In an observational study, Ko and colleagues enrolled 1,147 patients with CKD (median age was 59.9±12.2 years; 53.6% were men) from the prospective observational cohort of Cardiovascular and Metabolic Disease Etiology Research Center-High Risk. Using bioelectrical impedance analysis, researchers classified patients into hypovolemic, euvolemic and hypervolemic groups based on fluid status.
BP patterns were determined using 24-hour BP measurements. These included dipper (nighttime BP fall 10% to 20%), extreme dipper (nighttime BP fall >20%), non-dipper (nighttime BP fall 0% to 10%) and reverse dipper (nighttime BP fall <0%).
“The primary outcome was nonfatal myocardial infarction, nonfatal stroke and all-cause mortality,” Ko said.
The median follow-up of 42.1 months revealed cardiovascular events occurred in 3.7% of the hypervolemic group and CKD progression occurred in 30.1%.
The Kaplan-Meier analysis revealed the hypervolemic group correlated with increased risk of cardiovascular events and CKD progression compared with hypovolemic group. Similarly, multivariable Cox analyses showed the hypervolemic group was associated with a heightened risk of cardiovascular events
The hypervolemic group also correlated with increased risk of reverse-dipping pattern and increased risk of CKD progression.
“The increased risks of cardiovascular events, mortality and progression of kidney disease in CKD patients with fluid overload can be explained by an interactive association with a reverse-dipping BP pattern,” Ko said. “Concomitant management of 24-hour BP patterns in CKD patients with fluid overload may improve the patient’s prognosis.”
Limitations of the study include its observational design and that few major adverse cardiovascular events occurred, according to the researchers.