Does a lack of nighttime blood pressure dipping predict kidney outcomes in CKD patients with normal blood pressure?

Details

A non-dipping nighttime blood pressure pattern predicts future decline in kidney function, but it was unclear whether it remains a risk for chronic kidney disease (CKD) patients with normal blood pressure. To investigate, researchers conducted a retrospective cohort study of 1,107 CKD patients who underwent ambulatory blood pressure monitoring (ABPM).

Patients were divided into four groups according to nighttime blood pressure pattern (dipper or non-dipper) and average 24-hour blood pressure (hypertension or normotension). The researchers analyzed the cumulative incidence of a composite kidney outcome: a 40% reduction in estimated glomerular filtration rate (eGFR), initiation of kidney replacement therapy, or death from kidney-related causes.

Overall, 86.1% of participants were non-dippers, and 48.2% of those non-dippers were normotensive. During a median follow-up of 4.72 years, the composite outcome incidence was highest among hypertensive non-dippers and was similar among normotensive dippers and non-dippers.

In multivariate regression, 24-hour systolic blood pressure, the amount of urinary protein, and hemoglobin values were associated with kidney outcomes. The researchers concluded that, in their ABPM-based analysis, a non-dipping pattern in patients with normal blood pressure did not predict future composite kidney outcomes in CKD patients.