Acknowledgements
This work is supported in part by the Ministry of Health, Labour and
Welfare, Japan. No potential conflicts of interest relevant to this
article exist. The sponsor had no role in the design and conduct of the
study. The authors also thank Mami Haga, Natsuko Tada and Yoko Chino,
Niigata University Faculty of Medicine, for excellent secretarial
assistance.
Disclosure: There is no risk of disclosure of the identity of
all the participants. We could not obtain signed informed consent in all
the participants, the opportunity to opt-out was accepted in all the
participants.
Abstract:
Aims: To determine associations between severity of
hypertension and risk of starting dialysis in the presence or absence of
diabetes mellitus (DM).
Methods: A nationwide database with claims data on 258,874
people with and without DM aged 19-72 y in Japan was used to elucidate
the impact of severity of hypertension on starting dialysis. Initiation
of dialysis was determined from claims using ICD-10 codes and medical
procedures. Using multivariate Cox modeling, we investigated severity of
hypertension as a predictor of the initiation of dialysis with and
without DM.
Results: Hypertension was significantly associated with the
initiation of dialysis regardless of DM. The incidence of starting
dialysis in those with SBP ≤119 mmHg and DM (DM+) was almost the same as
in those with SBP ≥150 mmHg and absence of DM (DM-). In comparison with
SBP ≤119 mmHg, SBP ≥150 mmHg significantly increased the risk of the
initiation of dialysis about 2.5 times regardless of DM+ or DM-.
Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150 mmHg was
6.88 (95% CI 3.66-12.9).
Conclusions: Although the risks of hypertension differed only
slightly regardless of the presence or absence of DM, risks for the
initiation of dialysis with DM+ and SBP ≤119 mmHg were equivalent to DM-
and SBP ≥150 mmHg, indicating more strict blood pressure interventions
in DM+ are needed to avoid dialysis. Future studies are needed to
clarify the cut-off SBP level to avoid initiation of dialysis
considering the risks of strict control of blood pressure.
●What is already known about this subject?
- Since dialysis adversely affects the quality of life and is related to
high rates of cardiovascular events and mortality, avoiding the need
for dialysis is clinically relevant.
- Both hyperglycemia and hypertension are highly predictive of kidney
disease.
●What does this article add?
- Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150 mmHg
was 6.88 (95% CI 3.66-12.9).
- The risks of hypertension were not very different between DM+ and DM-.
- Risks for the initiation of dialysis with DM+ and SBP ≤119 mmHg were
equivalent to DM- and SBP ≥150 mmHg, indicating stricter blood
pressure interventions in DM+ are needed to avoid dialysis.