Importance Of Non–dipping Pattern In Chronic Kidney Disease Patients

ABSTRACT

Introduction: Hypertension was prevalent in 80 to 90% of patients with chronic kidney disease (CKD), Hypertension was widely known to accelerate the progression of CKD and increase the risk of cardiovascular (CV) events. In essential hypertension, it was observed that 24hr ambulatory BP and a non–dipping profile were closely associated with increased target–organ damage and a worsened CV outcome than clinic BP. Objective: The purpose of this study was to evaluate the relation between non dipping pattern, traditional risk factors such as age, gender, cholesterol, asymptomatic atherosclerosis markers (LVMI, Carotid IMT, ABI) and cardiovascular mortality in CKD patients. Methodology: Patients attending hemodialysis unit and the outpatient department of the Osmania General Hospital were formed as the material of study. Results: According to the Sleep /Awake BP ratio> 0.9 in their ambulatory BP recordings; The percentage of non dipping pattern was observed in 72% and the remaining 28% had dipping phenomenon. The estimated glomerular filtration rate (eGFR) calculated by Modification of diet in renal disease study (MDRD) equation has ranged around 4.8 to 77 ml/mim/1.73m2 and was negatively correlated with sleep/awake BP ratio. The percentage of diabetes was observed to be higher in the non–dippers. The non–dipping phenomenon was significantly associated with asymptomatic atherosclerosis markers (LVMI, Carotid IMT, and ABI). There was a high prevalence of CV events (1 in dipper and 17 in non–dippers) and CV related deaths (1 in dipper and 9 in non–dippers) in non dippers.