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336 LACK OF NOCTURNAL BP-DIP IS A STRONG PREDICTOR OF THE RENAL DYSFUNCTION

Objectives: We have reported that as renal function deteriorates, nocturnal dip in blood pressure (BP) is diminished to compensate for impaired daytime renal sodium excretion, and longer duration (dipping time) is required until BP dips during the night. We investigated whether the lack of nocturnal BP-dip can predict the renal dysfunction. Methods: 198 patients with chronic kidney disease (CKD) (male 98, female 100, age 49±19, eGFR 58±36 ml/min/1.73m2, mean follow-up, 34 months), who have undergone 24-h ambulatory BP monitoring, were studied. The subjects were grouped into 2 according to the presence or absence of the nocturnal BP-dip (nocturnal BP reached <90% of the daytime average). The primary outcome was the composite of a doubling of the base-line serum creatinine concentration, or end-stage renal disease. Analysis was by intention to treat. Results: Twenty-seven out of 68 subjects with no nocturnal BP-dip reached the primary endpoint, whereas 19 out of 130 subjects with nocturnal BP-dip (40 vs. 155, p=0.0001). Compared with the subjects with nocturnal BP-dip, those without nocturnal BP-dip exhibited higher risk for the primary endpoint (HR 3.95; 95%CI, 2.09-7.44; p=0.00005), and the risk was increased 10% accompanied by 30 min extension of the DT. Adjusted for baseline eGFR, the risk was similar in both groups. Conclusions: The lack of the nocturnal BP-dip was a strong predictor for future renal dysfunction. Simultaneously, the nocturnal BP-dip was definitely determined by the renal function. Therefore, the present findings support our postulation that the kidney itself determines the sodium sensitivity and circadian rhythm of BP.