Hemodynamic phenotypes in chronic kidney disease patients based on linear regression of blood pressure parameters

Abstract

Classic and non‐classic cardiovascular (CV) risk factors accumulate in chronic kidney disease (CKD), contributing to vascular remodeling and hemodynamic abnormalities. This study aimed to determine hemodynamic phenotypes based on linear regression of blood pressure (BP) parameters in stage G3‐G4 CKD patients at very high CV risk. 24‐h ambulatory BP monitoring (ABPM), carotid‐femoral pulse wave velocity (PWV) and central BP were obtained from 52 patients (aged 60 ± 11 years, BMI 30 ± 6 kg/m2) with stage G3‐G4 CKD (eGFR 44 ± 12 mL/min./1.73 m2). Linear BP regression coefficients were generated to determine hemodynamic phenotypes using ABPM data. Coexisting hypertension was present in 45 (86%) patients, out of whom 33 (73%) had BP controlled. 24‐h mean systolic/diastolic BP was 128 ± 18/75 ± 12 mm Hg. Twenty‐six patients demonstrated the harmonious (H) and 26 patients diastolic dysfunctional (D) hemodynamic phenotypes. eGFR was not significantly different between both phenotypes. Compared to phenotype H, patients with phenotype D were older (57 ± 11 vs. 63 ± 10 years, p = .04), had higher PWV (8.2 [7.3–10.3] vs. 9.7 [8.3–10.9] m/s, p = .02), ambulatory arterial stiffness index (AASI) (0.31 ± 0.1 vs. 0.40 ± 0.1, p = .02), systolic BP (128 [122–130] vs. 137 [130–150] mm Hg, p = .001) and systolic BP variability (BPV) (11.7 ± 2.3 vs. 15.7 ± 3.4 mm Hg, p < .0001). Our findings suggest that one in two patients with stage G3‐G4 CKD demonstrates an unfavorable D hemodynamic phenotype based on a linear regression model, associated with higher PWV, AASI, systolic BP, and systolic BPV. Further studies are required to assess the clinical utility of hemodynamic phenotypes and whether the D phenotype may predict latent circulatory disorders and outcomes.