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Effect of blood pressure trajectory and variability on new-onset chronic kidney disease in patients with type 2 diabetes

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Abstract

This study aimed to evaluate the effects of BP trajectory and variability on chronic kidney disease (CKD) incidence in patients with type 2 diabetes. This retrospective longitudinal study included 4,560 participants with type 2 diabetes, aged ≥30 years, free of CKD, with ≥3 years of follow-up, and who attended the Diabetes Care Management Program in 2001–2013. The follow-up period ended in 2016. The adverse outcome was a new-onset CKD event, which was determined using eGFR and albuminuria. Cox proportional hazards models were used to assess the associations. At the end of the follow-up, 1255 participants had developed CKD, with a mean follow-up of 4.3 ± 3.2 years. Three trajectory subgroups of BP, i.e., Cluster 1: “moderate-stable” for SBP and “moderate-downward” for DBP, Cluster 2: “low-upward-downward” for both SBP and DBP, and Cluster 3: “high-downward-upward” for both SBP and DBP, were generated. The BP variability was grouped into three classes on the basis of tertiles. For the BP trajectory, patients in Cluster 3 of DBP had a higher CKD risk than those in Cluster 1 (HR = 1.24, 95% CI = 1.03–1.50). For the BP variability, patients in Tertile 3 had a significantly higher CKD risk than those in Tertile 1 (SBP: 1.28, 1.11–1.47; DBP: 1.17, 1.02–1.34). Persons with type 2 diabetes who achieved a small reduction in DBP after participating in the education program but rebounded and those who had the highest variation in both SBP and DBP faced the highest increase in CKD risk.

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Acknowledgements

This study was supported primarily by the Ministry of Science and Technology of Taiwan (MOST 104-2314-B-039-016 & MOST 105-2314-B-039-021-MY3 & MOST 105-2314-B-039-025-MY3 & MOST 107-2314-B-039-049 & MOST 108-2314-B-039-039 & MOST 108-2314-B-039-035-MY3 & MOST 108-2314-B-039-031-MY2 & MOST 109-2314-B-039-031-MY2 & MOST 110-2314-B-039-021-) and the China Medical University Hospital (DMR-110-076).

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Author notes

  1. These authors contributed equally: Cheng-Chieh Lin, Chia-Ing Li.

Authors and Affiliations

  1. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, ROC

    Cheng-Chieh Lin, Chia-Ing Li, Chiu-Shong Liu & Chih-Hsueh Lin

  2. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan, ROC

    Cheng-Chieh Lin, Chiu-Shong Liu & Chih-Hsueh Lin

  3. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC

    Cheng-Chieh Lin & Chia-Ing Li

  4. Department of Geriatrics and Gerontology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan, ROC

    Mu-Cyun Wang

  5. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, ROC

    Shing-Yu Yang & Tsai-Chung Li

  6. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan, ROC

    Tsai-Chung Li

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Lin, CC., Li, CI., Liu, CS. et al. Effect of blood pressure trajectory and variability on new-onset chronic kidney disease in patients with type 2 diabetes. Hypertens Res 45, 876–886 (2022). https://doi.org/10.1038/s41440-022-00882-8

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