The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Hypertension and CKD frequently coexist, and both are risk factors for cardiovascular events and mortality. Among people with hypertension, the loss of the normal fall in night-time BP, called nondipping, can only be diagnosed by ambulatory BP monitoring (ABPM) and is a risk factor for cardiovascular events. The pathophysiology of nondipping is complex, and CKD is an independent risk factor for nondipping. In fact, nondipping can be seen in as many as 80% of people with CKD. However, the evidence for nondipping as an independent risk factor or causal agent for adverse outcomes in CKD remains mixed. ABPM has been shown to be superior to clinical BP measurement for correlating with end-organ damage and prognosis in CKD. This review covers the evidence for the use of ABPM in CKD, the evidence linking ABPM patterns to outcome in CKD and the evidence for treatment of nondipping in CKD.