Change in GFR in relation to pulse rate, dipping blood pressure, anti-hypertensives, NLR and PLR in patients with chronic kidney disease

Abstract

This study aimed to evaluate change in glomerular filtration rate (GFR) in chronic kidney disease (CKD) patients in relation to certain 24-h ambulatory blood pressure monitoring (ABPM) parameters, anti-hypertensives and inflammatory markers. A total of 206 adult CKD patients (mean±SD age: 51.3±17.1 years, 54.9% were females) were included in this retrospective study. Data on patient demographics, comorbidity and medications, 24-h ABPM parameters (pulse rate and dipping systolic and diastolic BP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR)and GFR were recorded. The change in e-GFR values from baseline was evaluated with respect to study variables. There was a mean -1.5 mL/min/1.73m2(range -80.2 to 18.1) decline from baseline GFR during study period. The decrease in GFR from baseline was significantly lower in patients with vs. without diuretic therapy (median 1.2 vs. 0 mL/min/1.73m2, p=0.017). GFR change from baseline was positively correlated with patient age (r=0.145, p=0.040) as well as with the total (r=0.198, p=0.005), day-time (r=0.184, p=0.009) and night-time (r=0.219, p=0.003) pulse rate. No significant difference was noted in GFR change from baseline with respect to gender, antihypertensive medications other than diuretics, the dipping systolic or diastolic BP values or inflammatory markers. Our findings revealed significant correlation of age, pulse rate and diuretic usage but not dipping systolic or diastolic BP or inflammatory markers with the GFR change from baseline.

Keywords

• Chronic kidney disease
• hypertension
• renal progression
• dipping blood pressure
• antihypertensive medications
• inflammatory markers

References

1. 1. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013; 382(9888): 260-272.
2. 2. Grams ME, Yang W, Rebholz CM, Wang X, Porter AC, Inker LA, et al. Risks of adverse events in advanced CKD: the chronic renal insufficiency cohort (CRIC) study. Am J Kidney Dis. 2017; 70(3): 337-346.
3. 3. Duru H. The prevalence and severity of mental health problems and sexual dysfunction in hemodialysis patients before and during the COVID-19 pandemic. Ther Apher Dial. 2022 Jan 27. Epub ahead of print. doi: 10.1111/1744-9987.13805.
4. 4. Jhee JH, Nam BY, Lee CJ, Park JT, Han SH, Kang SW, et al. Soluble Urokinase-Type Plasminogen Activator Receptor, Changes of 24-Hour Blood Pressure, and Progression of Chronic Kidney Disease. J Am Heart Assoc. 2021; 10(1): e017225.
5. 5. Cha RH, Lee H, Lee JP, Kim YS, Kim SG. The influence of blood pressure patterns on renal outcomes in patients with chronic kidney disease: The long-term follow up result of the APrODiTe-2 study. Medicine (Baltimore). 2020; 99(8): e19209.
6. 6. Hamrahian SM. Management of Hypertension in Patients with Chronic Kidney Disease. Curr Hypertens Rep. 2017; 19(5): 43.
7. 7. Kuczera P, Kwiecień K, Adamczak M, Bączkowska T, Gozdowska J, Madziarska K, et al. Different Relevance of Peripheral, Central or Nighttime Blood Pressure Measurements in the Prediction of Chronic Kidney Disease Progression in Patients with Mild or No-Proteinuria. Kidney Blood Press Res. 2018; 43(3): 735-743.
8. 8. Salles GF, Reboldi G, Fagard RH, Cardoso CR, Pierdomenico SD, Verdecchia P, et al. Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis. Hypertension. 2016; 67(4): 693-700.

9. 9. Kuramoto M, Aizawa M, KuramotoY, Okabe M, Sakata Y, Aizawa Y. Blood Pressure Increases Before Pulse Rate During the Nocturnal Period in Hypertensive Patients. Int Heart J. 2020; 61(3): 579-584.
10. 10. Minutolo R, Agarwal R, Borrelli S, Chiodini P, Bellizzi V, Nappi F, et al. Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease. Arch Intern Med. 2011; 171(12): 1090-1098.
11. 11. Whittle J, Lynch AI, Tanner RM, Simpson LM, Davis BR, Rahman M, et al. Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT. Clin J Am Soc Nephrol. 2016; 11(3): 471-480.
12. 12. McMullan CJ, Lambers Heerspink HJ, Parving H-H, Dwyer JP, Forman JP, de Zeeuw D. Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial. Am J Kidney Dis. 2014; 64(5): 714-722.
13. 13. Sahutoglu T, Sakaci T. Diastolic blood pressure variability in 24 hour-ABPM and outcomes of chronic kidney disease. Clin Nephrol. 2018; 90(1): 46-52.
14. 14. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006; 354(22): 2368-2374.
15. 15. Mae Y, Takata T, Ida A, Ogawa M, Taniguchi S, Yamamoto M, et al. Prognostic Value of Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio for Renal Outcomes in Patients with Rapidly Progressive Glomerulonephritis. J Clin Med. 2020; 9(4): 1128.
16. 16. Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail. 2012; 34(2): 155-159.
17. 17. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013; 17(3): 391-396.
18. 18. Wang S, Dong L, Pei G, Jiang Z, Qin A, Tan J, et al. High Neutrophil-To-Lymphocyte Ratio Is an Independent Risk Factor for End Stage Renal Diseases in IgA Nephropathy. Front Immunol. 2021; 12: 700224.
19. 19. Li Q, Chen P, Shi S, Liu L, Lv J, Zhu L, et al. Neutrophil-to-lymphocyte ratio as an independent inflammatory indicator of poor prognosis in IgA nephropathy. Int Immunopharmacol. 2020; 87: 106811.
20. 20. Davidson MB, Hix JK, Vidt DG, Brotman DJ. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Arch Intern Med. 2006; 166(8): 846-852.
21. 21. Duru H, Kara E. The relationship between blood pressure variability and renal progression in hypertensive patients with chronic kidney disease. Gevher Nesibe J Med Health Sci. 2021; 6(14): 80-88.
22. 22. Di Iorio B, Pota A, Sirico ML, Torraca S, Di Micco L, Rubino R, et al. Blood pressure variability and outcomes in chronic kidney disease. Nephrol Dial Transplant. 2012; 27(12): 4404-4410.
23. 23. Manios E, Tsagalis G, Tsivgoulis G, Barlas G, Koroboki E, Michas F, et al. Time rate of blood pressure variation is associated with impaired renal function in hypertensive patients. J Hypertens. 2009; 27(11): 2244-2248.
24. 24. Briet M, Collin C, Karras A, Laurent S, Bozec E, Jacquot C, et al. Arterial remodeling associates with CKD progression. J Am Soc Nephrol. 2011; 22(5): 967-974.
25. 25. Cha RH, Lee H, Lee JP, Kang E, Song YR, Kim YS, et al. Changes of blood pressure patterns and target organ damage in patients with chronic kidney disease: results of the APrODiTe-2 study. J Hypertens. 2017; 35(3): 593-601.
26. 26. Stróżecki P, Pluta A, Donderski R, Włodarczyk Z, Manitius J. Abnormal diurnal blood pressure profile and hypertension-mediated organ damage in nondiabetic chronic kidney disease G1-G3b patients. Blood Press Monit. 2021; 26(1): 22-29.
27. 27. Mojón A, Ayala DE, Piñeiro L, Otero A, Crespo JJ, Moyá A, et al. Comparison of ambulatory blood pressure parameters of hypertensive patients with and without chronic kidney disease. Chronobiol Int. 2013; 30(1-2): 145-158.
28. 28. Benetos A, Salvi P, Lacolley P. Blood pressure regulation during the aging process: the end of the 'hypertension era'?. J Hypertens. 2011; 29(4): 646-652.
29. 29. Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010; 375(9718): 906-915.