EFFECT OF LONG-TERM BLOOD PRESSURE VARIABILITY ON THE FUTURE DEVELOPMENT OF CHRONIC KIDNEY DISEASE: THE KOREAN NATIONAL INSURANCE HEALTH CHECKUP STUDY

Objective: Chronic kidney disease (CKD) is a significant global health concern, marked by progressive and irreversible nephron loss that can lead to end-stage renal disease, cardiovascular complications, and premature mortality. Despite hypertension being the primary driver of CKD, the impact of long-term blood pressure (BP) fluctuations on CKD development remains unclear. To address this gap, we explored the relationship between BP variabilities over time and the future onset of CKD. Design and method: We screened all individuals over 40 years of age who underwent a health examination during the screening period (from 2002 to 2009, n=246,874), and excluded individuals with less than 3 BP measurements, those who died, and those with pre-existing CKD. New-onset CKD was identified during the follow-up period (from 2010 to 2019). BP variability was calculated with variability independent of the mean (VIM), and multivariate analysis with Cox proportional hazards analysis was used to assess VIM with new-onset CKD. Results: We calculated VIM of systolic blood pressure (VIM-SBP), diastolic BP (VIM-DBP), mean BP (VIM-MBP) and pulse pressure (VIM-PP) in a total of 62,570 adults (29,222 women, 51.9±6.4 years old). New-onset CKD was identified in 4,272 individuals during the follow-up period. In the univariate analysis, the fourth quartile of VIM-SBP, VIM-DBP, VIM-MBP, and VIM-PP was associated with increased incidence of new-onset CKD (Figure). However, VIMs of BP did insignificantly associated with new-onset CKD.Conclusions: We found that increased BP variability, as assessed by VIM of SBP, DBP, MBP and PP, was associated with increased new-onset CKD. However, their correlations were insignificant after adjusting other variables.