Ambulatory Blood Pressure in Chronic Kidney Disease

Abstract

Abstract Chronic kidney disease (CKD) affects approximately 20 million adults in the United States. Patients with CKD have an increased risk of cardiovascular (CV) disease. Ambulatory blood pressure monitoring (ABPM) provides superior BP measurements when compared to office BP measurements in normotensive, hypertensive and CKD patients. ABPM measurements are often abnormal in CKD, with CKD patients frequently showing an altered circadian rhythm with an increased rate of non-dipping and reverse dipping. The prevalence of non-dippers and reverse-dippers increases progressively as stage of CKD progresses. ABPM has been shown to be a better tool for predicting CV risk, CKD progression, end stage renal disease (ESRD) or death than officebased pressures. ABPM is also additive and adds prognostic value for predicting CKD and CV outcomes when added to estimated glomerular filtration rate (eGFR). Although ABPM is time consuming, it is worth considering, as the data demonstrates that information from ABPM can potentially impact future CVand renal outcomes in patients with CKD. increased risk of cardiovascular disease (CVD), and many CKD patients die before reaching the need for dialysis often from CVD [1]. There is constant debate about the optimal blood pressure (BP) goals for the non-dialysis CKD population, with ongoing studies in this area (Systolic Blood Pressure Intervention Trial [SPRINT]) [2]. It is well documented that ambulatory blood pressure monitoring (ABPM) provides superior BP measurements when compared to clinic or office BP measurements in the general population. However, most studies have assessed office BP measurements when evaluating progression of CKD and current BP guidelines for non-dialysis CKD are based on office BP measurements. Abnormal ABPM measurements are commonplace in CKD, and the prognostic value of ABPM for renal and cardiovascular (CV) outcomes are now becoming clearer. This review will focus on the circadian pattern of ABPM in normal, hypertensive and CKD patients, and the role of ABPM in determining CKD progression and CVD risk in the CKD population.