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Difference in SBP between arms is a predictor of chronic kidney disease development in the general Korean population

Kim, Gwang-Sil*; Byun, Young Sup*; Lee, Hye Young; Jung, In Hyun; Rhee, Kun Joo; Kim, Byung Ok

doi: 10.1097/HJH.0000000000001931

Objective: An increased inter-arm SBP difference (IASBPD) is associated with mortality and cardiovascular events, as well as peripheral vascular disease, which is attributed to subclavian stenosis. The aim of the present study was to investigate the association between the IASBPD and incident chronic kidney disease (CKD) in the Korean population.

Methods: A retrospective cohort study was performed on 8780 Korean adults without baseline CKD. The bilateral blood pressure was measured sequentially and repeatedly at the first visit. IASBPD was defined as a BP at least 15 mmHg according to the National Institutes for Health and Clinical Excellence guidelines, and CKD was defined as an estimated glomerular filtration rate less than 60 ml/min per 1.73 m2. We assessed the value of IASBPD to predict the incidence of CKD and investigated cardiovascular disease, including coronary heart disease and stroke.

Results: Over a mean follow-up period of 8.5 years, 96 of 581 (16.5%) patients in the IASBPD group and 1037 of 8199 (12.6%) patients in the non-IASBPD group developed incident CKD. Compared with the non-IASBPD, an IASBPD was associated with incident CKD [hazard ratio (HR): 1.336, 95% confidence interval (CI): 1.08–1.65, P = 0.007]. After adjusting for potential confounders, including age, sex, hypertension, diabetes, and obesity, we found that the hazard ratio was also robust (hazard ratio 1.275, 95% CI 1.03–1.58, P = 0.024).

Conclusion: Increased IASBPD is an independent predictor of incident CKD in the general population.

Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea

Correspondence to Byung Ok Kim, MD, Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Dongil-ro 1342, Nowon-gu, Seoul 01757, Republic of Korea. Tel: +82 29501266; fax: +82 29501248; e-mail:

Abbreviations: 5-HT, 5-hydroxytryptamine; ABI, ankle–brachial index; BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; HbA1c, hemoglobin A1c level; HOMA IR, homeostatic model assessment of insulin resistance; IASBPD, inter-arm SBP pressure difference; NICE, National Institutes for Clinical Excellence

Received 17 December, 2017

Accepted 3 August, 2018

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