title: Riser pattern is a predictor of kidney mortality among patients with chronic kidney disease.
abstract: BACKGROUND
  Hypertension is a crucial risk factor for cardiovascular death and loss of residual kidney function. Absence of the nocturnal decline in blood pressure (BP) predicts cardiovascular events and poor prognosis. However, characteristics of hypertension in moderate-to-severe chronic kidney disease (CKD) have not been fully evaluated. We aimed to assess the circadian variation of BP and kidney survival in CKD patients.
  
  
  METHODS
  Patients who were examined by 24-h ambulatory BP monitoring (ABPM) and estimated glomerular filtration rate (eGFR), <45 ml/min/1.73 m(2), were enrolled in the study. The impacts of BP circadian rhythm and brain natriuretic peptide (BNP) on kidney survival were evaluated.
  
  
  RESULTS
  A total of 124 patients were enrolled. The average age was 64 ± 14 years, 57% were male, and 43% had diabetes. Forty-five percent of patients had a non-dipper pattern, 35% had a riser pattern, 19% had a dipper pattern, and 1% had an extreme-dipper pattern. The prevalence of diabetes and plasma BNP levels was higher and eGFR was lower in the riser-pattern group than in the non-riser-pattern group. Kidney survival rates were significantly worse in the riser-pattern group than in the non-riser-pattern group (p < 0.05). Moreover, among riser and non-riser pattern groups divided by BNP levels, the riser group with higher BNP level showed the worst kidney survival (p < 0.05).
  
  
  CONCLUSIONS
  The riser pattern is frequently associated with several conditions at higher risk for kidney survival. Patients with a rising pattern and higher BNP levels have a worse kidney prognosis.
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nakai
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Awata
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Kono
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Yonekura
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Goto
authors.affiliation: a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishi
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Ambulatory blood pressure monitoring; brain natriuretic peptide; diabetes; hypertension; kidney survival