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?
  1. 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.
  2. Both hyperglycemia and hypertension are highly predictive of kidney disease.
●What does this article add?
  1. Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150 mmHg was 6.88 (95% CI 3.66-12.9).
  2. The risks of hypertension were not very different between DM+ and DM-.
  3. 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.