Nocturnal Blood Pressure - Central and Peripheral 24-h Blood Pressure in Chronic Kidney Disease.

Study Overview
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Brief Summary
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A new study have shown that high nighttime blood pressure (BP) and/or non-dipping (lack of fall in blood pressure during nighttime) is a strong predictor for the risk of cardiovascular disease and mortality in patients with hypertension. Three factors seem to affect the night time blood pressure: chronic kidney disease, obstructive sleep apnea (OSA) or the way ambulatory blood pressure is monitored. The aim of this study is to analyse the importance of these three factors on nighttime bloodpressure. Hypothesis: Central 24 hour blood pressure monitoring provides another measure of daily fluctuations in blood pressure than peripheral 24 hour blood pressure monitoring, because measurement is painless and does not interfere with activities during the daytime or night-time sleep In chronic kidney disease and OSA the decrease in nocturnal BP is lower than in healthy subjects. In chronic kidney disease the decrease in the nocturnal BP is inversely correlated to the severity of OSA, the severity of kidney disease, and blood pressure during daytime.

Detailed Description
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150 patients with chronic kidney disease (CKD III-IV) and 75 healthy subject is examined with both central and peripheral 24 hours blood pressure monitoring, 1 night home polygraphy to determine whether the subject has obstructive sleep apnea, and if so the degree (AHI), blood- and urine samples to determine levels of u-AQP2 og u-ENaCɣ, PRC, p-AngII, p-Aldosterone, p-Avp og p-Endothelin.

Official Title
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Nocturnal Blood Pressure in Chronic Kidney Disease, Obstructive Sleep Apnea and Healthy Subjects - Central and Peripheral 24-h Blood Pressure.

Conditions
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Chronic Kidney Disease, Obstructive Sleep Apnea

Participation Criteria
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Eligibility Criteria
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Patients, group 1: Inclusion Criteria: eGFR 15-59 mL/min/1.73 m2 (estimated GFR) 18-80 years males and females Exclusion Criteria: lack of desire to participate treatment for OSA malignant disease Abuse of drugs or alcohol pregnant and lactating incompensated heart failure atrial fibrillation liver disease (ALAT> 200) Severe chronic obstructive lung disease (forced expiratory volume in 1 second <50% predicted) Healthy Subjects: inclusion criteria Healthy volunteers men and women age 40 - 80 years BMI within the normal range, ie. between 18.5 to 25.0 kg/m2 exclusion Criteria Arterial hypertension, ie. ambulatory blood pressure> 130 mmHg systolic and / or 80 mmHg diastolic. a history or clinical signs of cardial, pulmonary, hepato, renal, endocrine, cerebral or neoplastic disorders Alcohol abuse, ie. > 14 drinks / week for women and> 21/uge for men Substance abuse Daily medicine intake/ treatment apart from oral contraceptives Smoking Pregnancy or breastfeeding Lack of desire to participate Clinically significant, discrepant results of blood or urine sample at inclusion study (ie B-hemoglobin and B-White blood cell count, p-Sodium, p-Potassium, p-creatinine, p-ALAT, p-bilirubin , p-alkaline phosphatase, p-cholesterol, p-albumin or b-glucose and urine for hematuria, albuminuria or glucosuria) Clinically significant differences in the electrocardiogram Blood Donation for the past month preceding the day on the first attempt sequence.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic kidney disease, CKD III+IV<br>150 patients with Chronic kidney disease, CKD stage III+IV. | |
| Healthy subjects<br>75 healthy subjects. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| decrease in peripheral systolic blood pressure at night | The difference in the decrease in systolic blood pressure at night by peripheral 24-h BP between patients with chronic kidney disease and healthy subjects. | < 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| decrease in central systolic blood pressure at night | The difference in the decrease in systolic BP at night by central 24-h BP between patients with chronic kidney disease and healthy subjects. | < 24 hours | 
| difference in peripheral and central systolic and diastolic blood pressure throughout the day, during the daytime and during nighttime | The difference in systolic blood pressure and diastolic blood pressure throughout the day, during the daytime and during nighttime between measurements with peripheral 24-hour monitoring and central 24 hour monitoring in both patients with chronic kidney disease and healthy subjects. | < 24 hours | 
| The correlation between the decrease in nighttime blood pressure on the one hand and severity of OSA, severity of kidney disease and blood pressure during the daytime on the other. |  | < 24 hours | 
| U-AQP2 (urine aquaporin 2) og u-ENaCɣ (urine epithelial sodium channel) | 24 hour urine sample. | 24 hours | 
| PRC (plasma renin concentration), p-AngII (angiotensin II), p-Aldosterone. P-Avp (vasopressin), p-Endothelin. |  | < 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic kidney disease, 24 hour blood pressure, central blood pressure, peripheral blood pressure, obstructive sleep apnea