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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus

Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
DOI: 10.1136/jim-2020-001489 Published 18 December 2020
Taeko Osawa
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Kazuya Fujihara
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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  • ORCID record for Kazuya Fujihara
Mayuko Harada Yamada
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Masahiko Yamamoto
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Masaru Kitazawa
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Yasuhiro Matsubayashi
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Midori Iwanaga
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Takaho Yamada
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Hiroyasu Seida
2Japan Medical Data Center Co Ltd, Tokyo, Japan
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Satoru Kodama
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Yoshimi Nakagawa
3Department of Internal Medicine, University of Tsukuba School of Medicine, Tsukuba, Japan
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Hitoshi Shimano
3Department of Internal Medicine, University of Tsukuba School of Medicine, Tsukuba, Japan
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Hirohito Sone
1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Abstract

To determine associations between severity of hypertension and risk of starting dialysis in the presence or absence of diabetes mellitus (DM). A nationwide database with claims data on 258 874 people with and without DM aged 19–72 years in Japan was used to elucidate the impact of severity of hypertension on starting dialysis. Initiation of dialysis was determined from claims using International Classification of Diseases-10 codes and medical procedures. Using multivariate Cox modeling, we investigated the severity of hypertension to predict the initiation of dialysis with and without DM. Hypertension was significantly associated with the initiation of dialysis regardless of DM. The incidence of starting dialysis in those with systolic blood pressure (SBP) ≤119 mm Hg and DM (DM+) was almost the same as in those with SBP ≥150 mm Hg and absence of DM (DM−). In comparison with SBP ≤119 mm Hg, SBP ≥150 mm Hg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM−. Compared with DM− and SBP ≤119 mm Hg, the HR for DM+ and SBP ≥150 mm Hg was 6.88 (95% CI 3.66 to 12.9). Although the risks of hypertension differed only slightly regardless of the presence or absence of DM, risks for starting dialysis with DM+ and SBP ≤119 mm Hg were equivalent to DM− and SBP ≥150 mm Hg, indicating more strict blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are required to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure.

Footnotes

  • Contributors TO and KF developed the study design, researched the data, contributed to discussions, wrote the manuscript and reviewed and edited the manuscript. HS planned and supervised this research, researched the data, contributed to discussions, wrote the manuscript and reviewed and edited the manuscript. MHY, MY, MK, YM, MI, TY and SK researched the data, contributed to discussions, wrote the manuscript and reviewed and edited the manuscript. YN and HS researched the data and reviewed and edited the manuscript. HS developed the study design, contributed to discussions and reviewed and edited the manuscript and supervised this research.

  • Funding This study is funded by the Japan Society for the Promotion of Science. This work is supported in part by the Ministry of Health, Labour and Welfare, Japan.

  • Disclaimer The sponsor had no role in the design and conduct of the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Ethics Committee of the Niigata University approved this study (2015–2410).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Vol 70 Issue 8 Table of Contents
Journal of Investigative Medicine: 70 (8)
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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
Journal of Investigative Medicine Dec 2020, jim-2020-001489; DOI: 10.1136/jim-2020-001489

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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
Journal of Investigative Medicine Dec 2020, jim-2020-001489; DOI: 10.1136/jim-2020-001489
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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
Taeko Osawa, Kazuya Fujihara, Mayuko Harada Yamada, Masahiko Yamamoto, Masaru Kitazawa, Yasuhiro Matsubayashi, Midori Iwanaga, Takaho Yamada, Hiroyasu Seida, Satoru Kodama, Yoshimi Nakagawa, Hitoshi Shimano, Hirohito Sone
Journal of Investigative Medicine Dec 2020, jim-2020-001489; DOI: 10.1136/jim-2020-001489
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