PubMed ID:
38212425
Public Release Type:
Journal
Publication Year: 2024
Affiliation: 1 Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
2 Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
3 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
4 Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
5 Department of Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, USA
6 The Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
7 Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, USA
8 Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
9 Department of Nephrology and Hypertension, Department of Medicine, Wayne State University, Detroit, MI, USA
10 Kidney Health Research Institute, Department of Population Health Sciences, Geisinger, Danville, PA, USA
11 Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
DOI:
https://doi.org/10.1038/s41371-023-00884-0
Authors:
FitzGerald GA,
Skarke C,
Cohen J,
Rao P Bhat Z,
Jamal NE,
de Sosa GR,
Townsend R,
Shah V,
Brooks TG,
Yang W,
Drawz PE,
Nelson RG,
Chang A
Request IDs:
22857
Studies:
African American Study of Kidney Disease Study Group
,
Chronic Renal Insufficiency Cohort Study
Chronic kidney disease (CKD) incurs a significant global burden. Hypertension is a modifiable risk factor for rapid progression of CKD. We extend the risk stratification by introducing the non-parametric determination of rhythmic components in 24-hour profiles of ambulatory blood pressure monitoring (ABPM) in the African American Study for Kidney Disease and Hypertension (AASK) cohort and the Chronic Renal Insufficiency Cohort (CRIC). We find that CRIC participants with a history of CVD and absent cyclic components in their BP profile had at any time a 3.4-times higher risk of cardiovascular death than participants with cyclic components present in their BP profile (HR: 3.38, 95% CI: 1.45-7.88, p=0.005). This substantially increased risk was independent of whether ABPM followed a dipping or non-dipping pattern (p>0.1). Those without rhythmic components in blood pressure had the highest incidence rate of cardiovascular death (18.46 [14.30-23.82] per 1000 person years) compared to other ABPM derived parameters such as uncontrolled 24-hour blood pressure (17.20 [13.10-22.63] per 1000 person years), non-dipping pattern (16.11[12.03-21.58] per 1000 person years) and dipping pattern (12.55 [8.10-19.45] per 1000 person years). In the subgroup analysis, reverse dippers without cyclic components were at an 8-fold higher risk of dying from cardiovascular causes compared to reverse dippers with retained rhythms (HR: 8.0, 95% CI: 0.99-63.8, p=0.05). In the AASK cohort, unadjusted models demonstrate a higher risk in reaching end stage renal disease among participants without rhythmic ABPM components (HR:1.80, 95% CI: 1.10-2.96); however, full adjustment abolished this association. In conclusion, rhythmic profiling of BP profiles through JTK_Cycle analysis identifies subgroups of CRIC participants at advanced risk of cardiovascular death. This creates opportunities to engage this subgroup of patients for enhanced clinical risk management.