Kidney Week

Abstract: FR-PO023

Clinical Impact of Kidney Educational Program on Elderly Nocturnal Hypertensive Patients with CKD

Session Information

• Classroom to Bedside: Transforming Medical Education
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

• 1000 Educational Research

Authors

• Ishii, Akira, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Akira Ishii, MD, PhD, DrPH

• Sato, Ryo, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Ryo Sato

• Mochizuki, Kosuke, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Kosuke Mochizuki, MD

• Otsuka, Kansei, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Kansei Otsuka

• Fujita, Kyoka, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Kyoka Fujita

• Kurahashi, Satoshi, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Satoshi Kurahashi, MD

• Takeoka, Jun, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Jun Takeoka, MD

• Hirashima, Hisako, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Hisako Hirashima, APN

• Toda, Naohiro, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Naohiro Toda, MD, PhD

• Komiya, Toshiyuki, Otsu Red Cross Hospital, Shiga, Japan

Toshiyuki Komiya, MD, PhD

• Muso, Eri, Kansai Denryoku Igaku Kenkyujo, Osaka, Osaka, Japan

Eri Muso, MD, PhD

Background

It has been reported that hypertension progresses with age and the rhythm of blood pressure variability is disrupted in the elderly due to autonomic dysfunction and arterial stiffness, which can easily induce nocturnal hypertension. Furthermore, elderly patients with nocturnal hypertension are recognized as being at higher risk of cardiovascular events and chronic kidney disease (CKD) exacerbation. We aimed to elucidate the clinical impact of renal educational program on elderly nocturnal hypertensive CKD patients.

Methods

We reviewed 60 Japanese CKD patients who participated in our one-week CKD educational program from April 2019 to March 2023. All patients took low-salt diet (6 g/day) and were carried out 24-hour urine testing twice and 24-hour ambulatory blood pressure monitoring (ABPM) during the program.

Results

The mean age on admission was 71.6 ± 8.5 years, body mass index (BMI) was 25.6 ± 3.6, and eGFR was 19.2 ± 10.3. Diabetic kidney disease was the most common diagnosis (38% [22 of 58]), followed by nephrosclerosis (19% [11 of 58]), IgA nephropathy (3.4% [2 of 58]) and so on. Of the patients, 25 (43.1%) were non-dipper type and 12 (20.7%) were riser type (these two types (63.8%) were combined into the non-dipper group). During one-week program, the mean body weight decreased from 68.4 to 66.9 kg (2.2% reduction), systolic blood pressure during daytime decreased from 136.9 to 129.9 mmHg (5.1% reduction), urinary protein decreased from 4.10 to 3.93 g/day (4.1% reduction) and the 24-hour urinary sodium excretion decreased from 121.7 mEq/day to 106.1 mEq/day (12.8% reduction). The non-dipper group had a higher BMI but had similar daytime systolic blood pressure and diabetes mellitus complication rates compared with the dipper group. Furthermore, while the non-dipper group showed a decrease in the slope of the pressure-natriuresis curve, there was no obvious difference in the rate of eGFR decrease after one year of hospitalization between two groups.

Conclusion

While the non-dipper group showed increased salt sensitivity compared to the dipper group, there was no obvious difference in the degree of renal function decline after one year of intervention, which was considered by multifaceted intervention effect of CKD education, such as salt reduction instruction.