title: Blood pressure variability and outcomes in chronic kidney disease.
abstract: BACKGROUND
  We investigated the effects of visit-to-visit systolic blood pressure variability (SBPV) on both mortality and dialysis inception in a cohort of chronic kidney disease (CKD) patients not requiring dialysis therapy. Furthermore, we also explored the carry-over effect of visit-to-visit SBPV on mortality after dialysis initiation.
  
  
  METHODS
  We conducted a longitudinal retrospective, observational, multi-centre study in three tertiary care nephrology outpatient clinics. All the ambulatory CKD patients admitted to the outpatient clinics from 1 January 2004 to 31 December 2005 were screened for study eligibility. We selected all consecutive patients older than 18 years of age with a mean estimated glomerular filtration rate of <60 mL/min/m(2), free from cardiovascular disease. SBPV was defined as the ratio of the SD to the mean SBP of five values recorded during a run-in phase of 4-5 months. Data on dialysis inception and mortality were recorded through 31 December 2010.
  
  
  RESULTS
  Overall, we selected a cohort of 374 elderly (median age: 79 years) subjects. A total of 232 (62%) and 103 (29%) patients were male and had diabetes, respectively. A significant association between SBPV and the risk of death but not of CKD progression to dialysis was noted at univariate and after multivariable adjustments (hazard ratio for all-cause mortality per 1% increase in SBPV: 1.05; 95% confidence interval: 1.02-1.09; P = 0.001). Notably, no lethal event was recorded after dialysis initiation.
  
  
  CONCLUSIONS
  Current findings suggest that SBPV may be of use for risk stratification in CKD patients.
authors.affiliation: Nephrology of Landolfi Hospital, Solofra AV, Italy. br.diiorio@gmail.com
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
authors.forename: Andrea
authors.initials: A
authors.lastname: Pota
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Sirico
authors.forename: Serena
authors.initials: S
authors.lastname: Torraca
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Micco
authors.forename: Roberto
authors.initials: R
authors.lastname: Rubino
authors.forename: Pasquale
authors.initials: P
authors.lastname: Guastaferro
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012189:Retrospective Studies