Nocturnal heart rate rising is a risk factor for poor renal outcomes in patients with chronic kidney disease and hypertension.

The association of heart rate (HR) dipping pattern with renal outcomes in chronic kidney disease (CKD) patients with hypertension has never been investigated. In order to demonstrate if HR dipping pattern is a risk factor for renal outcomes, cardiovascular (CV) diseases, and mortality in hypertensive patients with CKD, we conducted the prospective longitudinal observational study. Patients were divided into three groups according to their nocturnal HR: HR dippers (night-day HR ratio ≤ 0.9), HR non-dippers (0.9 < night-day HR ratio ≤ 1.0), and HR risers (night-day HR ratio > 1.0). The primary outcome was renal endpoint, a composite outcome of progression to end-stage renal disease (ESRD) or estimated glomerular filtration rate (eGFR) decline ≥ 50%; the secondary outcomes included poor renal outcomes, CV events, and death. A total of 34 (11.3%) patients reached renal endpoint after a follow-up of 34 ± 17 months. Both HR non-dippers and HR risers were predictive to renal endpoint (hazard ratio 2.58, 95% confidence interval (CI) 1.04- 6.4, P = .04; hazard ratio 3.95, 95% CI 1.33- 11.79, P = .01, respectively), while only HR risers was shown to be correlated with a decline in eGFR≥ 50% (hazard ratio 5.28, 95% CI 1.45-19.16, P < .05), and decline in eGFR (β -0.17, 95% CI -0.33- -0.01, P = .04). No predictive value was found for HR dipping pattern to mortality and CV events. In conclusion, our study provided the first evidence that HR non-dippers, especially risers were a risk factor for poor renal outcomes in hypertensive patients with CKD.