Effect of long-term blood pressure trajectory on the future development of chronic kidney disease: an analysis of data from the Korean National Insurance Health Checkup Study.

Objectives: Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD.

Methods: In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic BP (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed.

Results: In total, 111,900 adults (53,420 women, 51.9  6.4 years old) presented with 2 SBP trajectory classes: class 1 (n = 66,935) and class 2 (n = 44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.114; 95% confidence interval [CI], 1.989-2.246, p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in men (HR, 1.093; 95% CI, 1.005-1.189; p=0.037), but not in women (HR, 1.059; 95% CI, 0.947-1.184; p=0.321).

Conclusion: An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.