RT Journal Article SR Electronic T1 Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus JF Journal of Investigative Medicine JO J Investig Med FD BMJ Publishing Group Ltd SP 724 OP 729 DO 10.1136/jim-2020-001489 VO 69 IS 3 A1 Taeko Osawa A1 Kazuya Fujihara A1 Mayuko Harada Yamada A1 Masahiko Yamamoto A1 Masaru Kitazawa A1 Yasuhiro Matsubayashi A1 Midori Iwanaga A1 Takaho Yamada A1 Hiroyasu Seida A1 Satoru Kodama A1 Yoshimi Nakagawa A1 Hitoshi Shimano A1 Hirohito Sone YR 2021 UL http://hw-f5-jim.highwire.org/content/69/3/724.abstract AB 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.