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Liu J, Ma Y, Yu G, Wang W. Association between annual changes and visit-to-visit variability of serum uric acid and the kidney outcome in a general population. Ren Fail 2024; 46:2367702. [PMID: 38912897 PMCID: PMC11198116 DOI: 10.1080/0886022x.2024.2367702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 06/07/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND To determine whether variability of serum uric acid (UA) is associated with risk of chronic kidney disease (CKD) in a healthy population. METHODS Retrospective, longitudinal cohort study was conducted at a health examination center in China. The study enrolled subjects who had a minimum of three visits between 2011 and 2018. We assessed UA change and visit-to-visit UA variability including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). Rapid estimated glomerular filtration rate (eGFR) decline was defined by annual eGFR change < -4 mL/min/1.73 m2/year. We conducted a multivariable-adjusted logistic regression analysis. RESULTS Ten thousand seven hundred and thirty-eight participants were included. During 4.43 ± 1.31 years follow-up, there were 535 cases with rapid eGFR decline and 240 cases developed CKD. Compared to the non-rapid eGFR decline group and non-CKD group, the UA annual changes and variability were higher in the rapid eGFR decline group and CKD group. The highest quartile of UA annual changes and variability showed a higher incident rate of rapid eGFR decline and that of CKD. After adjusting for covariates, OR for eGFR rapid decline in UA variability were 1.69 [1.53, 1.86] for annual changes of UA, 1.17 [1.08, 1.27] for SD of UA, 1.16 [1.06, 1.25] for CV of UA, 1.16 [1.07, 1.25] for VIM of UA, and 1.10 [1.02, 1.19] for ARV of UA. Consistent results were observed when CKD is used as the outcome. CONCLUSIONS Higher variability of serum UA was independently associated with the risk of kidney impairment.
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Affiliation(s)
- Jian Liu
- Department of Nephrology, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuhua Ma
- Department of Nephrology, Traditional Chinese Medicine Hospital of Kunshan, Nanjing, China
| | - Geping Yu
- Department of Nephrology, Tonglu First People’s Hospital, Hangzhou, China
| | - Weiming Wang
- Department of Nephrology, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
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Yang L, Li J, Wei W, Pu Y, Zhang L, Cui T, Ma L, Wang B, Zhao Y, Fu P. Blood Pressure Variability and the Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis. J Gen Intern Med 2023; 38:1272-1281. [PMID: 36650323 PMCID: PMC10110830 DOI: 10.1007/s11606-022-08001-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Blood pressure variability (BPV) is a risk factor for poor prognosis including cardiovascular events, chronic kidney disease, and mortality, independent of elevated BP. METHODS We searched PubMed/Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 23, 2022. Cohort studies reporting the association between BPV and chronic kidney disease (CKD) progression were selected. Hazard ratios were pooled using a random-effects model. Meta-regression, subgroup analyses, and sensitivity analyses were conducted. RESULTS A total of 23 studies were included in this systematic review and meta-analysis. Increased BPV was associated with progression of CKD (HR: 1.21, 95% CI: 1.09-1.33) and incidence of ESRD (HR: 1.08, 95% CI: 1.08-1.30). Among the different BPV metrics, high variation independent of mean (VIM), coefficient of variation (CV), standard deviation (SD), and average real variability (ARV) were indicated as predictors of CKD progression. DISCUSSION Increased BPV was associated with CKD progression.
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Affiliation(s)
- Letian Yang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Jian Li
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Wei Wei
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Yajun Pu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Ling Zhang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Tianlei Cui
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Liang Ma
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Bo Wang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Yuliang Zhao
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China.
| | - Ping Fu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
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Tang C, Zhang XY, Lv JC, Shi SF, Zhou XJ, Liu LJ, Zhang H. Visit-to-visit variability in blood pressure and kidney disease progression in IgA nephropathy. Clin Kidney J 2022; 15:2331-2339. [PMID: 36381367 PMCID: PMC9664579 DOI: 10.1093/ckj/sfac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background The visit-to-visit variability (VVV) in blood pressure (BP) is an important risk factor for stroke and coronary heart disease and may also be associated with kidney damage and the development of chronic kidney disease (CKD). Data on the association between VVV in BP and the risk of CKD progression among patients with immunoglobulin A nephropathy (IgAN) are limited. We aimed to evaluate the relationships of VVV in BP with the progression of IgAN. Methods We assessed 1376 patients with IgAN at Peking University First Hospital. The main VVV in BP was expressed as the standard deviation (SD), coefficient of variation (CV) and average real variability (ARV). The associations of variability in BP with composite kidney disease progression events, defined as a 50% decline in estimated glomerular filtration rate (eGFR) and kidney failure, were examined using Cox models. Results During a median follow-up of 44.1 months (interquartile range 23.0–76.7), 247 (18.0%) patients experienced composite kidney disease progression events. With a higher SD in systolic BP (SBP) values, the risk of kidney disease progression events increased {hazard ratio [HR] 1.07 [95% confidence interval (CI) 1.03–1.11]; P < .001} after maximal adjustment, including baseline SBP and mean SBP during the first 12-month period. Using the first quartile of SD SBP values as the reference, the risk of composite kidney disease progression events was higher among patients with higher SD SBP values; the HR was 2.12 (95% CI 1.31–3.44) in the highest quartile (P for trend < .001). A similar trend could be observed when analysing the SD of diastolic BP, but the risk was not significantly increased. The associations were similar when analysed with the CV and ARV. Conclusion SBP variability was significantly associated with kidney disease progression in IgAN.
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Affiliation(s)
- Chen Tang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology , Beijing , China
- Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education , Beijing , China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing , China
| | - Xiao-Yan Zhang
- Renal Division, Yanqing Hospital, Beijing Traditional Chinese Medicine Hospital , Beijing , China
| | - Ji-Cheng Lv
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology , Beijing , China
- Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education , Beijing , China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing , China
| | - Su-Fang Shi
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology , Beijing , China
- Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education , Beijing , China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing , China
| | - Xu-Jie Zhou
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology , Beijing , China
- Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education , Beijing , China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing , China
| | - Li-Jun Liu
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology , Beijing , China
- Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education , Beijing , China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing , China
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology , Beijing , China
- Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education , Beijing , China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing , China
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Li Y, Song Y, Liu L, Wang X, Zhou Z, Zhang N, Wang Z, Chen P, Shi H, Huo Y, Xu X, Li J. Inverse Association Between Baseline Plasma Selenium Concentrations and Risks of Renal Function Decline in Hypertensive Adults. J Nutr 2022; 152:2754-2760. [PMID: 36083982 PMCID: PMC9839988 DOI: 10.1093/jn/nxac211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The kidney has the highest level of selenium (Se) in the body, but the role of plasma Se in chronic kidney disease is uncertain. OBJECTIVE We aimed to investigate the longitudinal association between baseline plasma Se and renal function decline in adults with hypertension and to explore possible effect modifiers. METHODS This was a post hoc analysis of 935 men and women with hypertension aged 40 to 75 years from a folic-acid intervention trial (the China Stroke Primary Prevention Trial) in China. The baseline plasma Se was analyzed both as a continuous variable and as tertiles. The primary outcome was a rapid decline in renal function, defined as a mean decline in the estimated glomerular filtration rate of ≥ 5 mL/(min × 1.73 m2) per year. RESULTS The median follow-up duration from baseline to outcome was 4.4 years. After multivariate adjustment, there was an inverse association between plasma Se and a rapid decline in renal function (per 10-unit increment; OR: 0.85; 95% CI: 0.73, 0.99). When the baseline plasma Se was assessed as tertiles, compared to the lowest tertile (<74.5 μg/L), a lower trend of the primary outcome was found in the second tertile (74.5 to < 89.4 μg/L; OR: 0.60; 95% CI: 0.34, 1.07) and the highest tertile (89.4 to <150 μg/L; OR: 0.42; 95% CI: 0.22, 0.80; Ptrend = 0.006). Furthermore, the Se-renal association was more pronounced among participants with folic acid treatment or with a higher baseline folate concentration (both Pinteraction values < 0.05). CONCLUSIONS In this sample of Chinese adults with hypertension, baseline plasma Se concentrations were inversely associated with the risk of renal function decline. The China Stroke Primary Prevention Trial was registered at clinicaltrials.gov as NCT00794885.
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Affiliation(s)
- Youbao Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China,National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangzhou, China,State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, China,Guangdong Provincial Institute of Nephrology, Guangzhou, China,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yun Song
- Shenzhen Evergreen Medical Institute, Shenzhen, China,Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Lishun Liu
- Shenzhen Evergreen Medical Institute, Shenzhen, China,Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ziyi Zhou
- Shenzhen Evergreen Medical Institute, Shenzhen, China,Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Nan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhuo Wang
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Ping Chen
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China,Key Laboratory of Cancer food for special medical purpose (FSMP) for State Market Regulation, Beijing, China,Inspection and Testing Center, Key Laboratory of Cancer FSMP for State Market Regulation, Shenzhen, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xiping Xu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China,National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangzhou, China,State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, China,Guangdong Provincial Institute of Nephrology, Guangzhou, China,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China,Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
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Park CH, Kim HW, Joo YS, Park JT, Chang TI, Yoo TH, Park SK, Chae DW, Chung W, Kim YS, Oh KH, Kang SW, Han SH. Association Between Systolic Blood Pressure Variability and Major Adverse Cardiovascular Events in Korean Patients With Chronic Kidney Disease: Findings From KNOW-CKD. J Am Heart Assoc 2022; 11:e025513. [PMID: 35656977 PMCID: PMC9238732 DOI: 10.1161/jaha.122.025513] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Whether visit-to-visit systolic blood pressure (SBP) variability can predict major adverse cardiovascular events (MACE) in patients with chronic kidney disease is unclear. Methods and Results We investigated the relationship between SDs of visit-to-visit SBP variability during the first year of enrollment and MACE among 1575 participants from KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into 3 groups according to tertiles of visit-to-visit SBP variability (SD). The study end point was MACE, defined as a composite of nonfatal myocardial infarction, unstable angina, revascularization, nonfatal stroke, hospitalization for heart failure, or cardiac death. During 6748 patient-years of follow-up (median, 4.2 years), MACE occurred in 64 participants (4.1%). Compared with the lowest tertile of visit-to-visit SBP variability (SD), the hazard ratios (HRs) for the middle and the highest tertile were 1.64 (95% CI, 0.80-3.36) and 2.23 (95% CI, 1.12-4.44), respectively, in a multivariable cause-specific hazard model. In addition, the HR associated with each 5-mm Hg increase in visit-to-visit SBP variability (SD) was 1.21 (95% CI, 1.01-1.45). This association was consistent in sensitivity analyses with 2 additional definitions of SBP variability determined by the coefficient of variation and variation independent of the mean. The corresponding HRs for the middle and highest tertiles were 2.11 (95% CI, 1.03-4.35) and 2.28 (95% CI, 1.12-4.63), respectively, in the analysis with the coefficient of variation and 1.76 (95% CI, 0.87-3.57) and 2.04 (95% CI, 1.03-4.03), respectively, with the variation independent of the mean. Conclusions Higher visit-to-visit SBP variability is associated with an increased risk of MACE in patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.
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Affiliation(s)
- Cheol Ho Park
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
| | - Young Su Joo
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine National Health Insurance Service Medical CenterIlsan Hospital Goyangshi Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
| | - Sue Kyung Park
- Department of Preventive Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnamsi Gyeonggi-do Republic of Korea
| | - Wookyung Chung
- Department of Internal Medicine Gil Medical CenterGachon University Incheon Republic of Korea
| | - Yong-Soo Kim
- Department of Internal Medicine Seoul St Mary's HospitalCollege of MedicineThe Catholic University of Korea Seoul Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine Seoul National University HospitalKidney Research Institute Seoul Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea
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Suh SH, Oh TR, Choi HS, Kim CS, Oh KH, Lee J, Oh YK, Jung JY, Choi KH, Ma SK, Bae EH, Kim SW. Association of Circulating Osteoprotegerin Level with Blood Pressure Variability in Patients with Chronic Kidney Disease. J Clin Med 2021; 11:jcm11010178. [PMID: 35011919 PMCID: PMC8745733 DOI: 10.3390/jcm11010178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/18/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Circulating osteoprotegerin (OPG) is a biomarker for cardiovascular complications that are closely related to chronic kidney disease (CKD). To investigate the association between circulating OPG level with long-term visit-to-visit blood pressure variability (BPV) in patients with pre-dialysis CKD, a total of 1855 subjects with CKD from stage 1 to pre-dialysis stage 5 from a prospective cohort were analyzed. Long-term visit-to-visit BPV was determined by average real variability (ARV), standard deviation (SD), and coefficient of variation (CoV) of systolic and diastolic blood pressure (SBP and DBP). ARV of SBP (Adjusted β coefficient 0.143, 95% confidence interval 0.021 to 0.264) was significantly associated with serum OPG level. Although SD and CoV of SBP were not significantly associated with serum OPG level in multivariate linear regression analyses, restricted cubic spline visualized the linear correlation of serum OPG level with all of ARV, SD, and CoV. The association between serum OPG level and DBP variability was not significant. Subgroup analyses revealed that the association of serum OPG with BPV is more prominent in the subjects with Charlson comorbidity index ≤3 and in the subjects without history of diabetes mellitus. In conclusion, circulating OPG level is potentially associated with long-term visit-to-visit BPV in patients with pre-dialysis CKD.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea;
| | - Joongyub Lee
- Department of Prevention and Management, School of Medicine, Inha University, Incheon 22212, Korea;
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University, Seoul 08826, Korea;
| | - Ji Yong Jung
- Department of Internal Medicine, Division of Nephrology, Gachon University of Gil Medical Center, Incheon 21565, Korea;
| | - Kyu Hun Choi
- Department of Internal Medicine, Institute of Kidney Disease Research, College of Medicine, Yonsei University, Seoul 03722, Korea;
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Correspondence: (E.H.B.); (S.W.K.); Tel.: +82-62-220-6503 (E.H.B.); +82-62-225-6271 (S.W.K.)
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61469, Korea; (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Correspondence: (E.H.B.); (S.W.K.); Tel.: +82-62-220-6503 (E.H.B.); +82-62-225-6271 (S.W.K.)
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Suh SH, Song SH, Oh TR, Choi HS, Kim CS, Bae EH, Oh KH, Lee J, Han SH, Kim YH, Chae DW, Ma SK, Kim SW. Association of Urinary Potassium Excretion with Blood Pressure Variability and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease. Nutrients 2021; 13:nu13124443. [PMID: 34959995 PMCID: PMC8706671 DOI: 10.3390/nu13124443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
Dietary potassium intake is a dilemma in patients with chronic kidney disease (CKD). We investigated the association of urine potassium excretion, a surrogate for dietary potassium intake, with blood pressure variability (BPV) and cardiovascular (CV) outcomes in patients with pre-dialysis CKD. A total of 1860 participants from a cohort of pre-dialysis CKD (KNOW-CKD) patients were divided into the quartiles by spot urine potassium-to-creatinine ratio. The first quartile (26.423 ± 5.731 mmol/gCr) was defined as low urine potassium excretion. Multivariate linear regression analyses revealed an independent association of low urine potassium excretion with high BPV (adjusted β coefficient 1.163, 95% confidence interval 0.424 to 1.901). Cox regression analyses demonstrated that, compared to high urine potassium excretion, low urine potassium excretion is associated with increased risk of CV events (adjusted hazard ratio 2.502, 95% confidence interval 1.162 to 5.387) but not with all-cause mortality. In conclusion, low urine potassium excretion is associated with high BPV and increased risk of CV events in patients with pre-dialysis CKD. The restriction of dietary potassium intake should be individualized in patients with pre-dialysis CKD.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
| | - Su Hyun Song
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 06591, Korea;
| | - Joongyub Lee
- Department of Prevention and Management, School of Medicine, Inha University, Incheon 22212, Korea;
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea;
| | - Yeong Hoon Kim
- Department of Nephrology, College of Medicine, Inje University, Busan 47392, Korea;
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
- Correspondence: (S.K.M.); (S.W.K.); Tel.: +82-62-220-6579 (S.K.M.); +82-62-225-6271 (S.W.K.)
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju 61496, Korea; (S.H.S.); (S.H.S.); (T.R.O.); (H.S.C.); (C.S.K.); (E.H.B.)
- Correspondence: (S.K.M.); (S.W.K.); Tel.: +82-62-220-6579 (S.K.M.); +82-62-225-6271 (S.W.K.)
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Zhang Q, Zhou B, Ma Y, Hu Y, Li X, Cong H. Blood pressure visit-to-visit variability and outcomes in patients with heart failure with preserved ejection fraction. ESC Heart Fail 2021; 8:3984-3996. [PMID: 34405581 PMCID: PMC8497211 DOI: 10.1002/ehf2.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
AIMS Previous studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fraction (HFpEF). This study sought to explore the association between visit-to-visit variability (VVV) of BP and clinical outcomes in patients with HFpEF. METHODS AND RESULTS A total of 1988 patients (mean age of 67.73 ± 9.22, 51.7% female) from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this study. BP-VVV was determined by standard deviation (SD) of mean systolic BP (SBP-SD) from six measurements (baseline and months 1, 2, 4, 8, and 12) during the first 12 months after randomization. Mean on-treatment SBP during the first 12 months was 127.77 ± 10.42 mmHg, and the median of SBP-SD was 8.15 mmHg. A total of 192 (9.7%) patients met the primary outcome during the subsequent median follow-up of 35.16 months, including a composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Multiple Cox regression analysis showed that SBP-SD was independently associated with the increased risk of the primary outcome after adjusting for age, gender, method of BP measurement, treatment, renal function and common co-morbidities, and the mean SBP during the first 12 months [hazard ratio (HR) for fourth vs. first quartile, 1.63; 95% confidence interval (CI), 1.07-2.49; P = 0.024]. Analysis showed that SBP-SD as continuous variable was associated with a 23% increase in the risk of primary outcome (HR 1.23, 95% CI 1.06-1.43; P = 0.006). CONCLUSIONS The findings of the current study show that high SBP-VVV in patients with HFpEF is associated with an increased risk of adverse outcomes independent of the mean on-treatment SBP.
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Affiliation(s)
- Qi Zhang
- Department of CardiologyTianjin Chest Hospital#261 Taierzhuangnan Road, Jinnan DistrictTianjinChina
| | - Bingyang Zhou
- Department of CardiologyTianjin Chest Hospital#261 Taierzhuangnan Road, Jinnan DistrictTianjinChina
| | - Yu Ma
- Department of CardiologyTianjin Chest Hospital#261 Taierzhuangnan Road, Jinnan DistrictTianjinChina
| | - Yuecheng Hu
- Department of CardiologyTianjin Chest Hospital#261 Taierzhuangnan Road, Jinnan DistrictTianjinChina
| | - Ximing Li
- Department of CardiologyTianjin Chest Hospital#261 Taierzhuangnan Road, Jinnan DistrictTianjinChina
- Tianjin Medical UniversityTianjinChina
- Chest HospitalTianjin UniversityTianjinChina
| | - Hongliang Cong
- Department of CardiologyTianjin Chest Hospital#261 Taierzhuangnan Road, Jinnan DistrictTianjinChina
- Tianjin Medical UniversityTianjinChina
- Chest HospitalTianjin UniversityTianjinChina
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Abstract
The prospective relation of dietary riboflavin intake with hypertension remains uncertain. We aimed to investigate the relationship of dietary riboflavin intake with new-onset hypertension and examine possible effect modifiers in general population. A total of 12 245 participants who were free of hypertension at baseline from China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or diagnosed by physician or under antihypertensive treatment during the follow-up. A total of 4303 (35.1%) subjects developed hypertension during 95 573 person-years of follow-up. Overall, there was a nonlinear, inverse association between total, plant-based, or animal-based riboflavin intake and new-onset hypertension (allPfor nonlinearity, <0.001). The risk of new-onset hypertension was increased only in participants with relatively lower riboflavin intake. Accordingly, a significantly lower risk of new-onset hypertension was found in participants in quartiles 2 to 4 of total riboflavin intake (hazard ratio, 0.74 [95% CI, 0.68–0.80]), plant-derived riboflavin intake (hazard ratio, 0.77 [95% CI, 0.71–0.84]), or animal-derived riboflavin intake (hazard ratio, 0.70 [95% CI, 0.65–0.77]), compared with those in quartile 1. In addition, the association between total riboflavin intake and new-onset hypertension was particularly evident in those with lower dietary sodium/potassium intake ratio (Pinteraction, <0.001). In summary, there was an inverse association between riboflavin intake and new-onset hypertension in general Chinese adults. Our results emphasized the importance of maintaining relatively higher riboflavin intake levels for the prevention of hypertension.
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Hung MH, Huang CC, Chung CM, Chen JW. 24-h ambulatory blood pressure variability and hypertensive nephropathy in Han Chinese hypertensive patients. J Clin Hypertens (Greenwich) 2020; 23:281-288. [PMID: 33222387 PMCID: PMC8029827 DOI: 10.1111/jch.14108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
Blood pressure (BP) is characterized by spontaneous oscillation over time, which is described as BP variability (BPV). The current study aimed to investigate whether short‐term BPV was correlated with hypertensive nephropathy in Han Chinese individuals with hypertension. A single‐center prospective cohort study of 300 Han Chinese participants with hypertension was conducted in Taiwan. Five different BPV parameters were derived from ambulatory BP monitoring (ABPM), including standard deviation (SD), weighted SD (wSD), coefficient of variation (CoV), successive variation (SV), and average real variability (ARV). Renal event was defined as > 50% reduction in baseline estimated glomerular filtration rate (eGFR). The average age of the participants was 63.5 years. The baseline eGFR was 84.5 mL/min/1.73 m2. The participants were divided into two groups according to the wSD of systolic BP (SBP). Survival was assessed via a Kaplan‐Meier analysis. During the 4.2‐year follow‐up, the participants with the highest SBP wSD tertile had a greater number of renal events (6.0%) than their counterparts (0.5%) (log‐rank test, p = .007). The Cox proportional hazard regression model was used to assess the independent effects of BPV, and results showed that 24‐h SBP (HR = 1.105; 95% CI = 1.020–1.197, p = .015) and 24‐h DBP (HR = 1.162; 95% CI = 1.004–1.344, p = .044) were independently associated with renal events. However, BPV parameters were only associated with renal events univariately, but not after adjusting for baseline characteristics, 24‐h mean BP, and office BP. Therefore, the risk of hypertensive nephropathy was independently associated with 24‐h mean BP, but not with ambulatory BPV, in Han Chinese participants with hypertension.
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Affiliation(s)
- Ming-Hui Hung
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chia-Min Chung
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, ROC
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Zhang Y, Qin X. Urinary vanin-1 and chronic kidney disease in hypertensive patients. J Clin Hypertens (Greenwich) 2020; 22:1466-1468. [PMID: 32762139 DOI: 10.1111/jch.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yuanyuan Zhang
- Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Li H, Xue J, Dai W, Chen Y, Zhou Q, Chen W. Visit-to-visit blood pressure variability and risk of chronic kidney disease: A systematic review and meta-analyses. PLoS One 2020; 15:e0233233. [PMID: 32469904 PMCID: PMC7259502 DOI: 10.1371/journal.pone.0233233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Previous studies have shown that visit-to-visit blood pressure variability (BPV) is associated with chronic kidney disease (CKD). However, the results have not been consistent among studies. This systematic review and meta-analysis was conducted to comprehensively assess the association between visit-to-visit BPV and the risk of CKD. Methods Medline, Embase, and the Cochrane Library were searched from the date of inception through 1 August 2019 using the terms “blood pressure variability,” “chronic kidney disease,” “nephropathy,” and other comparable terms. The primary outcome was the development of CKD. Two reviewers extracted the data independently. Meta-analysis was performed using a random effects model. Results Fourteen studies were included in the systematic review and meta-analysis. The risk of CKD was significantly greater in patients with high baseline systolic blood pressure variability (SBPV) than in patients with low baseline SBPV: the standard deviation (SD) showed relative risk (RR) of 1.69 and 95% CI of 1.38–2.08, the coefficient of variation (CV) showed RR of 1.23 and 95% CI of 1.12–1.36, and variance independent of mean (VIM) showed RR of 1.40 and 95% CI of 1.15–1.71. RRs for each unit increase in visit-to-visit SBPV and risk of CKD were 1.05 (95% CI: 1.03–1.07) for SD, 1.06 (95% CI: 1.03–1.09) for CV, and 1.1 (95% CI: 0.96–1.25) for VIM. Diastolic BPV was similarly predictive of CKD based on SD and CV. Conclusions Increased visit-to-visit BPV might be an independent risk factor for CKD. However, significant heterogeneity was present; thus, future prospective studies are needed to confirm our findings. Our results indicate that treatment of hypertension should control blood pressure levels and prevent abnormal fluctuations in blood pressure to reduce the risk of CKD.
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Affiliation(s)
- Huihui Li
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Xue
- Department of Scientific Research, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenjie Dai
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yusa Chen
- Laboratory of Kidney Disease, Department of Nephrology, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Qiaoling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenhang Chen
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- * E-mail:
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