196 Diastolic Blood Pressure May Be an Early Modifiable Risk Factor in Preventing Aortic Stiffness Among Chronic Kidney Disease Patients

Background The frequency of low-turnover bone disease (LTBD) in patients with chronic kidney disease (CKD) has increased in past years. This change is important because LTBD is associated with bone pain, growth delay, and higher risk for bone fractures and extraosseous calcifications. LTBD is a histological diagnosis. However, serum markers such as parathyroid hormone (PTH) and calcium levels offer a noninvasive alternative for diagnosing these patients. Objective To describe the prevalence of LTBD in pediatric patients with renal failure undergoing some form of renal replacement therapy, using serum calcium and intact PTH levels as serum markers. Methods In this cross-sectional study, 41 children with CKD undergoing dialysis treatment (31 on continuous ambulatory peritoneal dialysis and 10 on hemodialysis) were included. There were no inclusion restrictions with respect to gender, cause of CKD, or dialysis modality. The children were studied as outpatients. The demographic data, CKD course, time on dialysis, phosphate-binding agents, and calcitriol prescription were registered, as well as weight, height, Z-score for height, linear growth rate, and Z-score for body mass index. Serum calcium, phosphorus, aluminum, PTH, alkaline phosphatase, osteocalcin, glucose, creatinine, urea, cholesterol, and triglycerides were measured. Results There were 20 (48.8%) children with both PTH <150 pg/mL and corrected total calcium >10 mg/dL who were classified as having LTBD[(+)]; the remaining 21 (51.2%) children were classified as having no LTBD[(–)]. The LTBD(+) patients were younger (11.2 ± 2.7 vs 13.2 ± 2.4 years, p < 0.01) but they had no differences regarding Z-scores for height. Linear growth in 6 months was less than expected in both groups (-0.15 ± 0.23 cm/month), but the difference between expected and observed growth was higher in the LTBD(+) group (-0.24 ± 0.14 vs –0.07 ± 0.28 cm/mo, p < 0.03). LTBD(+) patients also had lower serum creatinine (8.69± 2.75 vs 11.19 ± 3.17 mg/dL, p < 0.01), higher serum aluminum levels [median (range) 38.4 (9 – 106) vs 28.1 (9 – 62) μg/L, p < 0.05], and lower systolic blood pressure (112.0 ± 10.3 vs 125.0 ±12.9 mmHg, p < 0.015) and diastolic blood pressure (76.0 ± 9.7 vs 84.5 ± 8.2 mmHg, p < 0.017). A significant correlation was found between PTH and alkaline phosphatase ( r = 0.68, p < 0.001), but not between PTH and aluminum. Conclusion The LTBD(+) biochemical profile was found in 48.8% of the children and was associated with impaired linear growth. Aluminum contamination, evidenced by higher serum aluminum levels, may have had a pathogenic role in these disorders. Higher systolic and diastolic blood pressure levels may be related to higher serum PTH levels.

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Determiner of Poor Sleep Quality in Chronic Kidney Disease Patients Links to Elevated Diastolic Blood Pressure, hs-CRP, and Blood-count-based Inflammatory Predictors

The Indonesian Biomedical Journal ◽

10.18585/inabj.v11i1.452 ◽

2019 ◽

Vol 11 (1) ◽

pp. 100-6

Author(s):

Maulana Antiyan Empitu ◽

Ika Nindya Kadariswantiningsih ◽

Mochammad Thaha ◽

Cahyo Wibisono Nugroho ◽

Eka Arum Cahyaning Putri ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Sleep Quality ◽

Diastolic Blood Pressure ◽

Blood Count ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Lymphocyte Ratio ◽

Hs Crp

BACKGROUND: Sleep deprivation is strongly associated with cardiovascular disease (CVD) via sympathetic overstimulation and systemic inflammation in general population. However, the significance of poor sleep quality in chronic kidney disease (CKD) is still underexplored.METHODS: This study assessed the sleep quality of 39 with non-dialysis CKD (ND CKD) patients and 25 hemodialysis CKD (HD CKD) patients using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Poor sleeper was defined as individual with PSQI > 5.RESULTS: The prevalence of poor sleeper (30% vs. 60%, p=0.029) and the cummulative PSQI (ND CKD 4.5±4.4, HD CKD 8±6, p=0.038) are different between ND CKD and HD CKD groups. Among the ND CKD, there are association between short sleep duration (< 5 hours per day) with elevated diastolic blood pressure groups (r=0.421, p<0.05); habitual sleep efficiency with platelet-to-lymphocyte ratio (r= 0.532, p<0.0001); daytime dysfunction with increased hs-CRP (r=0.345, p=0.032) and neutrophil-to-lymphocyte ratio (r=0.320, p=0.046). In HD CKD group, a requirement to use sleep medication was associated with elevated highsensitivity C-reactive protein (hs-CRP) level (r=0.434, p=0.030) and decreased monocyte-to-lymphocyte ratio (r=- 0.410, p=0.042); daytime dysfunction was associated with serum hs-CRP (r=0.452, p=0.023).CONCLUSION: This study revealed that some features of poor sleep quality in CKD patients including low sleep efficiency, daytime dysfunction and requirement to use sleep medication were associated with increased diastolic blood pressure, hs-CRP and blood-count-based inflammatory predictors. Thus, this finding prompt to pay closer attention to sleep complaints in the management of CVD risk factors in CKD patients.KEYWORDS: sleep quality, chronic kidney disease, blood pressure, inflammation

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Lower Diastolic Blood Pressure was Associated with Higher Incidence of Chronic Kidney Disease in the General Population Only in those Using Antihypertensive Medications

Kidney & Blood Pressure Research ◽

10.1159/000501828 ◽

2019 ◽

Vol 44 (5) ◽

pp. 973-983

Author(s):

Daisuke Uchida ◽

Ryo Kido ◽

Hiroo Kawarazaki ◽

Masaru Murasawa ◽

Ayami Ando ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Diastolic Blood Pressure ◽

Estimated Glomerular Filtration Rate ◽

Antihypertensive Medications ◽

Adjusted Risk ◽

General Japanese Population ◽

Incidence Of Ckd

Background/Aims: The association of diastolic blood pressure (DBP) with incidence of chronic kidney disease (CKD) in the general population is not well examined. Methods: Using national health check-up database from 2008 to 2011 in the general Japanese population aged 39–74 years, we evaluated the association between DBP and incidence of CKD 2 years later in 127,954 participants without CKD. DBP was categorized by every 5 mm Hg from the lowest (<60 mm Hg) to the highest category (>100 mm Hg) and was further stratified into those with and without antihypertensive medications (BP meds). We calculated the OR for estimating adjusted risk of incident CKD using logistic regression model. Results: Participants were 62% female and 25.9% with BP meds, mean age of 76 years with estimated glomerular filtration rate of 78.2 ± 13.4 and DBP of 76 ± 11 mm Hg. Two years later, 12,379 (9.7%) developed CKD. Compared to DBP 60–64 mm Hg without BP meds as reference, multivariate analysis showed no difference in CKD risk at any DBP category among those without BP meds. However, in those with BP meds, risk increased according to lower DBP from 95 to 60 mm Hg (p for trend 0.05) with OR 1.51 (95% CI 1.14–1.99) in DBP <60 mm Hg. In subgroup analysis within those with or without BP meds, CKD risk was lower at higher DBP (p for trend 0.02) only in those without BP meds. Conclusion: Lower DBP was associated with higher risk of incident CKD only in the general population taking antihypertensive medication.

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Abstract 4351: Albuminuria is a Risk Factor for Adverse Events in Heart Failure Independent of the Presence of Chronic Kidney Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_870-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Adheesh Agnihotri ◽

Kalkidan Bishu ◽

James Arnold ◽

Gary Gustafson ◽

Inder S Anand

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Risk Factor ◽

Kidney Disease ◽

Adverse Events ◽

Systolic Blood Pressure ◽

Left Ventricular ◽

Creatinine Ratio ◽

Albumin Creatinine Ratio

Background : Chronic kidney disease (CKD) is a known risk factor for adverse events in patients with heart failure (HF). Whether albuminuria defined as urine albumin creatinine ratio ≥30 mg/g with or without CKD is also a risk factor for adverse events, is unclear. Methods : Data was abstracted from the electronic medical records of 442 patients admitted to the Minneapolis VA Medical Center with a primary diagnosis of HF, and an outpatient measurement of albumin creatinine ratio between September 2002 and March 2006. Multivariable Cox regression analysis was used to determine the impact of albuminuria on mortality and hospitalizations for HF at 1-year. Results : Albuminuria was seen in 54% (238/442) patients at baseline. Patients with albuminuria were more likely to have edema, higher systolic blood pressure, left ventricular hypertrophy, lower eGFR and use of beta-blockers (all p<0.05). Albuminuria correlated (p<0.05) with serum creatinine (rho=0.23), systolic blood pressure (0.37), and LVEF (0.13). The presence of albuminuria did not increase the risk of death (HR 0.65, 95% CI 0.38 –1.11), but was strongly associated with the risk of hospitalization for HF at 1-year (HR 1.77, 95% CI 1.11–2.82, p=0.017) independent of age, gender, h/o HTN, DM, CAD, PVD, COPD, CKD, atrial fibrillation, EF, use of ACE-I, spironolactone and beta-blocker. Conclusion : The presence of albuminuria is an independent prognostic marker for hospitalizations for heart failure.

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Low Diastolic Blood Pressure and Chronic Kidney Disease Are Associated With Increased Mortality

JAMA ◽

10.1001/jama.2013.277706 ◽

2013 ◽

Vol 310 (12) ◽

pp. 1215 ◽

Cited By ~ 1

Author(s):

Mike Mitka

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Diastolic Blood Pressure

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Association of High Blood Pressure with Elevated Oxidative Stress, Inflammatory Marker and Albuminuria in Chronic Kidney Disease Patients

Journal of Medicine ◽

10.3329/jom.v20i1.38815 ◽

2019 ◽

Vol 20 (1) ◽

pp. 12-18 ◽

Cited By ~ 1

Author(s):

Mochammad Thaha ◽

Ika N Kadariswantiningsih ◽

Maulana A Empitu

Keyword(s):

Oxidative Stress ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Diastolic Blood Pressure ◽

Inflammatory Marker ◽

Reactive Oxygen Species Generation ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio

Background: Activation of renin-Angiotensin system in hypertension was believed to be major determinant in endothelial dysfunction, micro-inflammation, and reactive oxygen species generation. This study aimed to investigate the interaction of increased blood pressure with cardiovascular risk factors in chronic kidney disease (CKD). Materials & methods: The study was an observational study with cross-sectional design that consecutively enrolled CKD patients in Universitas Airlangga Hospital and two other hospitals in Surabaya, Indonesia. The resting blood pressure and kidney functions of the participants were examined. Malondialdehyde (MDA) and total antioxidant capacity (TAC) was measured in serum and used as oxidative stress markers. Serum hs-C-reactive protein (CRP), lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio were utilized as inflammatory markers, while urine albumin-to-creatinine ratio (ACR) was used as renal disease marker. The participants were grouped based on their systolic and diastolic blood pressure (SBP and DBP). The difference of marker levels between groups was tested using Mann-Whitney test. The correlation between SBP and DBP with inflammation, oxidative stress, and albuminuria was determined using Spearman’s test. Results: As many as 71 patients with CKD were enrolled in this study. As much as 37% of the participants had high SBP and 14% had high DBP. High SBP positively associated with MDA (P<0.05), hs-CRP (P<0.05), platelet-to-lymphocyte ratio (P<0.05), and ACR (P<0.0001) and negatively with lymphocyte-to-monocyte ratio (P<0.05) and TAC (P<0.0001). High DBP associated positively with ACR (P<0.05) and negatively with TAC (P<0.05). Conclusions: High systolic or diastolic blood pressure was significantly associated with inflammation, oxidative stress and albuminuria. Optimal blood pressure control may be one of strategies to prevent inflammation and oxidative stress among CKD patients. J MEDICINE JUL 2019; 20 (1) : 12-18

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Integrated central blood pressure–aortic stiffness risk score for cardiovascular risk stratification in chronic kidney disease

Physiology International ◽

10.1556/2060.105.2018.4.29 ◽

2018 ◽

Vol 105 (4) ◽

pp. 335-346 ◽

Cited By ~ 2

Author(s):

J Nemcsik ◽

Á Tabák ◽

D Batta ◽

O Cseprekál ◽

J Egresits ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Risk Score ◽

Aortic Stiffness ◽

Central Blood Pressure ◽

Central Systolic Blood Pressure ◽

Very High ◽

Risk Categories

Background and aims The aim of this study was to develop an integrated central blood pressure–aortic stiffness (ICPS) risk score to predict cardiovascular events. Methods It was a retrospective cohort study. A total of 100 chronic kidney disease (CKD) patients on conservative therapy were included. Pulse wave velocity (PWV), central systolic blood pressure (cSBP), and central pulse pressure (cPP) were measured. A score was assigned to tertiles of PWV (0–2), cPP (0–2), and cSBP (0 to the first and second and 1 to the third tertile) based on each parameter’s ability to individually predict cardiovascular outcome. The sum of these scores and three ICPS risk categories as predictors were studied. Finally, we compared discrimination of the ICPS risk categories with PWV, cSBP, and cPP. Results Adjusted for age and sex, patients in high and very high ICPS risk categories had increased cardiovascular risk (HR: 3.52, 95% CI: 1.65–7.49; HR: 7.56, 95% CI: 3.20–17.85, respectively). High and very high ICPS risk categories remained independent predictors in a model adjusted for multiple CV risk factors (HR: 4.58, 95% CI: 1.65–7.49; HR: 8.56, 95% CI: 3.09–23.76, respectively). ICPS risk categories (Harrell’s C: 0.723, 95% CI: 0.652–0.795) showed better discrimination than PWV (Harrell’s C: 0.659, 95% CI: 0.586–0.732, p = 0.028) and cSBP (Harrell’s C: 0.660, 95% CI: 0.584–0.735, p = 0.008) and there has been a tendency of significance in case of cPP (Harrell’s C: 0.691, 95% CI: 0.621–0.761, p = 0.170). Conclusion The ICPS score may clinically importantly improve the identification of CKD patients with elevated cardiovascular risk.

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Association between metabolic parameters and risks of anemia and electrolyte disturbances among stages 3–5 chronic kidney disease patients in Taiwan

BMC Nephrology ◽

10.1186/s12882-021-02590-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Adi Lukas Kurniawan ◽

Ya-Lan Yang ◽

Chien-Yeh Hsu ◽

Rathi Paramastri ◽

Hsiu-An Lee ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Blood Glucose ◽

Kidney Disease ◽

Diastolic Blood Pressure ◽

Fasting Blood Glucose ◽

Adverse Outcomes ◽

Metabolic Parameters ◽

Cross Sectional ◽

Electrolyte Disturbances

Abstract Background Anemia and electrolyte disturbances are adverse outcomes of chronic kidney disease (CKD). This study explored the association between metabolic parameters with anemia and electrolyte and mineral disorders among CKD patients in Taiwan. Methods This cross-sectional study with a total of 2176 CKD stages 3–5 patients were collected from the Department of Nephrology at Shuang Ho Hospital, Taipei Medical University through the “Chronic Kidney Disease Common Care Network” database from December 2008 to April 2019. A multivariable-adjusted logistic regression expressed as odd ratios (OR) was performed to assess the association of metabolic parameters with anemia and electrolyte and mineral disorders. Results Elevated diastolic blood pressure, fasting blood glucose, and glycated hemoglobin A1c (HbA1c) were associated with presence of anemia. Similarly, elevated fasting blood glucose and HbA1c were associated with hyponatremia (OR = 1.59 and 1.58, P for both < 0.01) and hypercalcemia (OR = 1.38 and 1.33, P for both < 0.05). There was no significant association in serum lipid levels with presence of anemia. However, total triglycerides, total cholesterol and low-density lipoprotein-cholesterol were only associated with presence of hypercalcemia (OR = 1.43, 1.95 and 3.08, respectively, P for all < 0.05). Conclusions Elevated diastolic blood pressure, fasting blood glucose, HbA1c and blood lipids are associated with anemia or electrolyte and mineral disorders in CKD patients.

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