May 28, 2021Frontiers in MedicineOpen Access

Seasonal Change in Home Blood Pressure Monitoring Is Associated With Renal Outcome and Mortality in Patients With Chronic Kidney Disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic Kidney Disease (n=507). Intervention: Consistent BP elevation in the wintertime vs. No consistent BP elevation in the wintertime. Primary outcome: Composite of ≥40% reduction in eGFR, end stage renal disease, or death (HR 1.72, 95% CI 1.09-2.72, p=0.0205).

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Key result

Consistent home blood pressure elevation from summertime to wintertime in patients with chronic kidney disease was significantly associated with a worse composite outcome of renal decline, end-stage renal disease, or death (HR 1.72).

Why the study?

Blood pressure variation may lead to poor cardiovascular and renal outcomes, but the pattern of seasonal blood pressure change and its link to outcomes in CKD patients remained to be investigated.

Does consistent home blood pressure elevation in wintertime predict worse renal outcomes and mortality in patients with chronic kidney disease?

Population

507 outpatients with CKD living in southern Taiwan

Comparison

Four seasonal BP variation patterns based on average systolic BP changes between wintertime and summertime

Design

Retrospective analysis of a prospective observational cohort

Authors

CSChun Yin SeeNational Cheng Kung University Hospital CTChien-Tzu Tseng WLWei-Ren LinNational Cheng Kung University Hospital

Discussion

Member takes

Implication

Winter BP elevation may flag higher-risk CKD; leaves open whether seasonal home monitoring improves outcomes.

Study Design

Type

Cohort (n=507)

Multicenter

Structured PICO

Does consistent home blood pressure elevation in wintertime predict worse renal outcomes and mortality in patients with chronic kidney disease?

Population

507 outpatients with chronic kidney disease (generally stage ≥3b) aged 20 years or older, followed for a mean of approximately 55 months.

Exposure

Consistent home blood pressure elevation in wintertime (consistently higher average systolic BP ≥8 mmHg in wintertime than summertime).

Comparator

Other patterns of seasonal blood pressure variation (consistently lower BP in wintertime, large variation without specific pattern, or stable BP with <8 mmHg fluctuation).

Outcome

Composite of ≥40% reduction in estimated glomerular filtration rate (eGFR), end stage renal disease (initiation of dialysis or transplantation), or death.composite

Main Result

Hazard Ratio: 1.72 (95% CI 1.09–2.72)

Absolute Event Rate: 57% vs 35%

p-value: p=0.0205

Home blood pressure monitoring and the absence of wintertime blood pressure elevation are associated with better renal and survival outcomes in patients with chronic kidney disease.

Limitations

Single tertiary center with a relatively small sample size and few events.
BP and clinical data were collected from electronic medical records, so consistency and accuracy of BP measurement could not be confirmed.
Retrospective, cross-sectional study design limits causal inference.
Impact of high absolute BP on the seasonal BP change and outcomes was not evaluated.

Cite This Study

See et al. (2021) conducted a cohort in Chronic Kidney Disease (n=507). Consistent BP elevation in the wintertime vs. No consistent BP elevation in the wintertime was evaluated on Composite of ≥40% reduction in eGFR, end stage renal disease, or death (HR 1.72, 95% CI 1.09-2.72, p=0.0205). Consistent home blood pressure elevation from summertime to wintertime in patients with chronic kidney disease was significantly associated with a worse composite outcome of renal decline, end-stage renal disease, or death (HR 1.72).

synapsesocial.com/papers/6a71d40326770c2b8de13dd4 https://doi.org/10.3389/fmed.2021.672651

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Bookmark

Seasonal Change in Home Blood Pressure Monitoring Is Associated With Renal Outcome and Mortality in Patients With Chronic Kidney Disease

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Seasonal Change in Home Blood Pressure Monitoring Is Associated With Renal Outcome and Mortality in Patients With Chronic Kidney Disease

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

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