Chronic kidney disease (CKD) represents a significant global burden. Hypertension is a modifiable risk factor for rapid progression of CKD. We extend the risk stratification by introducing the non-parametric determination of rhythmic components in 24-h profiles of ambulatory blood pressure monitoring (ABPM) in the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study for Kidney Disease and Hypertension (AASK) cohort using Cox proportional hazards models. We find that rhythmic profiling of BP through JTK_CYCLE analysis identifies subgroups of CRIC participants that were more likely to die due to cardiovascular causes. While our fully adjusted model shows a trend towards a significant association between absent cyclic components and cardiovascular death in the full CRIC cohort (HR: 1.71,95% CI: 0.99–2.97, p = 0.056), CRIC participants with a history of cardiovascular disease (CVD) and absent cyclic components in their BP profile had at any time a 3.4-times higher risk of cardiovascular death than CVD patients with cyclic components present in their BP profile (HR: 3.37, 95% CI: 1.45–7.87, p = 0.005). This increased risk was not explained by the dipping or non-dipping pattern in ABPM. Due to the large differences in patient characteristics, the results do not replicate in the AASK cohort. This study suggests rhythmic blood pressure components as a potential novel biomarker to unmask excess risk among CKD patients with prior cardiovascular disease.

慢性肾病（CKD）是一个重大的全球负担。高血压是 CKD 快速进展的可改变危险因素。我们通过在慢性肾功能不全队列 (CRIC) 和非裔美国人肾脏疾病和高血压研究 (AASK) 的 24 小时动态血压监测 (ABPM) 曲线中引入节律成分的非参数确定来扩展风险分层使用 Cox 比例风险模型的队列。我们发现，通过 JTK_CYCLE 分析对血压进行节律分析，可以识别出更有可能因心血管原因死亡的 CRIC 参与者亚组。虽然我们的完全调整模型显示在整个 CRIC 队列中缺乏周期性成分与心血管死亡之间存在显着关联的趋势（HR：1.71，95% CI：0.99–2.97，p  = 0.056），但有心血管疾病史的 CRIC 参与者(CVD) 且血压谱中不存在周期性成分的患者在任何时候的心血管死亡风险比血压谱中存在周期性成分的 CVD 患者高 3.4 倍（HR：3.37，95% CI：1.45–7.87，p  = 0.005）。ABPM 的下降或非下降模式无法解释这种风险增加。由于患者特征存在巨大差异，该结果无法在 AASK 队列中重复。这项研究表明，节律性血压成分作为一种潜在的新型生物标志物，可以揭示既往患有心血管疾病的 CKD 患者的过度风险。