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Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus
  1. Taeko Osawa1,
  2. Kazuya Fujihara1,
  3. Mayuko Harada Yamada1,
  4. Masahiko Yamamoto1,
  5. Masaru Kitazawa1,
  6. Yasuhiro Matsubayashi1,
  7. Midori Iwanaga1,
  8. Takaho Yamada1,
  9. Hiroyasu Seida2,
  10. Satoru Kodama1,
  11. Yoshimi Nakagawa3,
  12. Hitoshi Shimano3,
  13. Hirohito Sone1
  1. 1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
  2. 2Japan Medical Data Center Co Ltd, Tokyo, Japan
  3. 3Department of Internal Medicine, University of Tsukuba School of Medicine, Tsukuba, Japan
  1. Correspondence to Dr Kazuya Fujihara, Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan; kafujihara-dm{at}


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.

  • diabetes mellitus
  • hypertension
  • kidney

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  • 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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