Nocturnal pulse rate correlated with ambulatory blood pressure and target organ damage in patients with chronic kidney disease

The relationship between resting pulse rate (PR) and the occurrence of hypertension and cardiovascular (CV) mortality has been described in the general population. Few studies have examined the relationship between ambulatory PR, ambulatory blood pressure (BP), and target organ damage (TOD) in patients with chronic kidney disease (CKD). A total of 1509 patients with CKD were recruited in our hospital. Ambulatory blood pressure monitoring (ABPM) over a 24‐hours period was performed and referenced with clinical data in this cross‐sectional study. TOD was measured by estimated glomerular filtration rate (eGFR), left ventricular hypertrophy (LVH), and carotid intima‐media thickness (cIMT). Univariate and multivariate analyses were used to evaluate the relationship between PR, BP, and TOD. The percentage of male patients was 58.3% with a mean age of 44.6 ± 16.2 years. Nocturnal PR rather than 24‐hours PR or daytime PR was an independent risk factor for clinical hypertension, 24‐hours hypertension, BP dipper state, poor renal function, and LVH. In addition, the authors found that nighttime PR >74 beats/min (bpm) group was independently associated with clinical hypertension, 24‐hours hypertension, day and night hypertension, nondipping BP, lower eGFR, and LVH when compared with nighttime PR <64 bpm group. Furthermore, 1:1 propensity score matching between PR ≤74 bpm group and PR >74 bpm group was performed. Multivariate analyses indicated nighttime PR >74 bpm remained independently associated with clinical hypertension, daytime and nighttime hypertension, and LVH. An increased nocturnal PR is associated with TOD, higher BP, and nondipping BP in patients with CKD.     

Prevalence of chronic kidney disease in patients with chronic hepatitis B: A cross‐sectional survey

Renal safety is a major concern during long‐term antiviral treatment for chronic hepatitis B (CHB). This study aimed to investigate the prevalence of chronic kidney disease (CKD) in patients with CHB that had been treated with antiviral therapy. This was a single‐centre, cross‐sectional study in a real‐life cohort in which all patients received antiviral treatment. Serum creatinine‐based equations from the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) were used to estimate the glomerular filtration rate (GFR). CKD was defined as an eGFR <60 mL/min/1.73 m² or a urinary albumin to creatinine ratio ≥ 3 mg/mmol (defined as albuminuria). Univariate and multivariate analyses were conducted to determine the risk factors of CKD. A total of 1985 patients were included in the analysis from February 2015 to December 2015. The mean age and median duration of antiviral treatment was 42.20 years and 17.05 months, respectively. The overall prevalence of CKD was 7.9% (157/1985), with 44 patients experiencing decreased renal function (eGFR less than 60 mL/min/1.73 m²) and 129 patients with albuminuria. Patients with cirrhosis had a higher prevalence of a decreased GFR (4.3% vs 1.6%, P<.001) and albuminuria (11.1% vs 5.2%, P<.001) than those without cirrhosis. In the multivariate analysis, hypertension (Odds Ratio [OR] 4.564, P<.001), diabetes mellitus (OR 2.688, P<.001) and cirrhosis (OR 1.918, P<.001) were independent factors associated with the presence of CKD. CKD was a clinically significant comorbidity in patients with CHB. Special attention should be paid to cirrhotic patients and patients with the metabolic syndrome.     

高血压患者动态动脉僵硬指数与血压变异性的关系

目的探讨高血压患者动态动脉僵硬指数(AASI)与血压变异性(BPV)的关系。方法入选2009-03-2011-10中国医科大学附属第一医院就诊的高血压患者119例,所有患者均行24h动态血压监测。AASI定义为1减去24h舒张压和收缩压的回归系数。依据AASI水平,分为4组:AASI<0.30、0.30～<0.41、0.41～<0.52、≥0.52。结果相关性分析显示,AASI分别与年龄(r=0.301,P<0.01)、24h收缩压(r=0.276,P=0.001)、白昼收缩压(r=0.225,P=0.008)、夜间收缩压(r=0.366,P<0.01)、24h脉压(r=0.510,P<0.01)、24h收缩压标准差(r=0.297,P=0.001)呈正相关,而与24h舒张压标准差(r=-0.256,P=0.002)、24h平均心率标准差(r=-0.205,P=0.017)及24h平均动脉压标准差(r=-0.202,P=0.017)呈负相关。多元线性逐步回归分析显示,AASI与24h脉压和24h收缩压标准差呈正相关(β=0.321,β=0.725,均P<0.01),与24h舒张压标准差和24h平均动脉压标准差呈负相关(β=-0.428,β=-0.346,均P<0.01)。结论 AASI与BPV密切相关。     

Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross‐sectional study

The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital‐based study. We conducted a cross‐sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD‐EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17‐1.36), low educational level aOR 1.7 (1.23‐2.35), duration of HPT OR, 1.02 (1.01‐1.04), and use of herbal medications aOR 1.39 (1.10‐1.75). Female gender was protective of CKD aOR 0.75 (0.62‐0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.     

高血压患者动态脉压和脉压指数与 并发冠心病的关系

目的 探讨高血压患者24 h动态脉压（24hPP）、24 h动态脉压指数（24hPPI）与并发冠心病的关系。方法 选取2019年1~6月期间在安康市中医医院接受治疗的高血压患者150例,根据是否合并冠心病将其分为高血压组（96例）,高血压合并冠心病组（54例）。比较两组患者的一般资料及24hPP、24hPPI,分析高血压患者合并冠心病的危险因素,分析高血压合并冠心病患者24hPP、24hPPI与Gensini积分的相关性,分析24hPP、24hPPI对高血压合并冠心病的预测价值。结果 高血压合并冠心病组患者的年龄[(62.57±7.42)岁比（58.63±8.92）岁]、吸烟史占比（37.04%比19.79%）、低密度脂蛋白胆固醇（LDL-C）[（2.98±0.64）mmol/L比（2.75±0.58）mmol/L]、24hPP[（50.52±9.37）mmHg比（47.26±8.69）mmHg]、24hPPI[（0.42±0.07）比（0.37±0.08）]均高于高血压组,高密度脂蛋白胆固醇（HDL-C）[（1.50±0.48）mmol/L比（1.68±0.52）mmol/L]低于高血压组,差异均有统计学意义（P<0.05）。补充数据;Logistic回归分析结果显示,年龄越大、LDL-C升高、24hPP升高、24hPPI升高均是高血压患者合并冠心病的危险因素,而不吸烟则是高血压患者合并冠心病的保护因素（P<0.05）;Pearson分析显示,24hPP、24hPPI与Gensini积分均呈正相关（P<0.05）;24hPP、24hPPI对高血压合并冠心病均有一定的预测价值,24hPP的曲线下面积为0.669（95%CI 0.577~0.762）,截断值取49.44 mm Hg时,敏感度为66.70%,特异度为63.50%,约登指数为0.302,24hPPI的曲线下面积为0.730（95%CI 0.646~0.813）,截断值取0.39时,敏感度为70.40%,特异度为72.90%,约登指数为0.433。结论 24hPP、24hPPI升高均是高血压患者合并冠心病的危险因素,且与Gensini积分均呈正相关,二者对高血压合并冠心病均有一定的预测、筛查价值,但24hPPI的预测、筛查价值更高。     

Noninvasive markers of arterial stiffness and renal outcomes in patients with chronic kidney disease

Our study aimed to explore the intercorrelations of brachial‐ankle pulse wave velocity (baPWV), ankle‐brachial index (ABI), ambulatory arterial stiffness index (AASI), 24‐hour mean pulse pressure (24‐h   PP), and augmentation index (AIx, AIx@75, the AIx standardized to a heart rate of 75) and compare the effectiveness of these markers for predicting renal outcomes. A total of 117 patients with chronic kidney disease (CKD) who received noninvasive arterial stiffness examinations were enrolled. We used correlation analysis and linear regression to explore the correlations between these five arterial stiffness markers and the Cox proportional hazards model and receiver operator characteristic (ROC) curve to assess the associations of markers with kidney disease outcomes. The median (interquartile range) of age and eGFR were 61 (49‐65) years and 50.5 (35.5‐84.1) ml/min/1.73 m², respectively. In Pearson correlation analysis, baPWV was significantly associated with 24‐h  PP (r = .531, p < .001), AIx@75 (r = .306, p < .001). Additionally, 24‐h  PP was associated with AASI (r = .507, p < .001) and AIx@75 (r = .217, p = .019). During follow‐up for a median of 25 months, 26.5% (n = 31) of patients had a composite outcome; of these, 10 initiated dialysis, 17 had 40% eGFR loss, and 4 died. Increased AASI, 24‐h  PP, and baPWV were associated with poor renal outcomes in a univariate Cox analysis. After adjusting for age, sex, MAP, eGFR, and 24 hours proteinuria, 1‐SD increase in AASI and 24‐h  PP was associated with renal outcomes. The ROC analysis yielded the largest area under the curve (AUC) of 0.727 (95% CI: 0.624 to 0.831; p < .001) for 24  ‐h PP. When the Youden''s index was at its maximum, the 24‐h PP value was 52 mmHg. In conclusion, 24‐h  PP, baPWV, and AIx@75 were linked well to one another. Arterial stiffness is a target for delaying the decline in kidney function. The use of 24‐h  PP as an arterial stiffness marker should be valued in CKD clinical practice.     

Association of renal function with the ambulatory arterial stiffness index and pulse pressure in hypertensive patients

Arterial stiffness exemplified by the ambulatory arterial stiffness index (AASI) and pulse pressure (PP) predicts cardiovascular morbidity and mortality. The present cross-sectional study assessed the association of renal function with AASI and 24-h PP in hypertensive inpatients. Subjects included 948 hypertensive inpatients with drug treatment (mean age, 53.3 years; male, 67.1%). The AASI was defined as 1 minus the regression slope of diastolic over systolic blood pressure readings obtained from 24-h recordings. Renal function was evaluated by serum creatinine and urinary albumin excretion was expressed by the urinary albumin-to-urinary creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) was calculated by the modification of diet in renal disease formula and chronic kidney disease-epidemiology collaboration formula. As AASI and 24-h PP increased, serum creatinine concentrations and ACR increased, and eGFR decreased. Multiple linear regression showed that AASI and 24-h PP were associated with eGFR-EPI (B=-12.00, P=0.001 vs. B=-0.14, P=0.002) and ACR (B=0.56, P=0.004 vs. B=0.01, P=0.017) independent of other cardiovascular risk factors. After additional adjustment for 24-h PP, the association of AASI with eGFR-EPI had borderline significance (P=0.053), whereas the significant associations of 24-h PP with serum creatinine and ACR persisted (P=0.009 and P=0.006) after adjusting for confounding factors and AASI. Multiple logistic regression analysis showed that each s.d. increase in 24-h PP (that is, 13?mm?Hg) was associated with a higher risk of suffering from microalbuminuria (MA) by 39% (P=0.038) after additional adjustment for AASI. In conclusion, AASI is more closely associated with eGFR compared with 24-h PP in hypertensive inpatients. However, for MA 24-h PP is a better predictor.     

Association of morning blood pressure surge with chronic kidney disease progression in patients with chronic kidney disease and hypertension

Blood pressure (BP) usually rise from being asleep to awake, which is named the morning blood pressure surge (MBPS). Researches have reported that elevated MBPS was related with CV events, incident CKD in hypertensive patients. However, there have been no studies that have investigated the association between MBPS and renal or heart outcomes in patients with CKD and hypertension, in these patients, the MBPS is much lower because of high prevalence of night hypertension and reduced BP dipping. In this prospective two‐center observational study, we enrolled patients with CKD and hypertension and the 24 h ambulatory blood pressure monitoring (ABPM) was conducted in all patients. Time to total mortality, CKD progression and CV events was recorded; Finally, a total of 304 patients were enrolled and 94 (30.9%) of them had elevated MBPS. After a follow‐up for median 30 months, 23 (7.6%), 34 (11.2%), and 95 (31.3%) patients occurred death, CKD progression and new‐onset CV events, respectively. The Cox regression analysis suggested the elevated MBPS was a strong predictor of CKD progression (HR 2.35, 95%CI 1.2 ‐4.63, p = .013), independent of morning BP, while no associations were found between elevated MBPS and CV events (HR 1.02, 95%CI 0.66 ‐1.57), as well as death (HR 1.08, 95%CI 0.46 ‐2.55). In conclusion, we provided the first evidence that elevated MBPS was an important risk factor of CKD progression in patients with CKD and hypertension. Appropriate evaluation and management of MBPS may be helpful to postpone CKD progression.     

Vascular remodeling and media calcification increases arterial stiffness in chronic kidney disease

Background: Cardiovascular disease is the most common cause of death in patients with chronic kidney disease (CKD). Arterial stiffness and calcification are non-traditional risk factors of cardiovascular disease in CKD. In CKD rats, we investigated the involvement of smooth muscle cells differentiation to osteoblast-like cells and blood vessel wall remodeling, associated with media calcification, in arterial stiffness.

Method: CKD with vascular calcification was induced by subtotal nephrectomy followed by treatment with a high calcium and phosphate diet, and vitamin D supplementation (Ca/P/VitD). At week 3–6, hemodynamic parameters and pulse wave velocity (PWV) were assessed. Vascular media calcification and remodeling were determined by histological von Kossa staining and confocal immunofluorescence analysis of osteocalcin, elastin, α-smooth muscle actin (α-SMA) and collagen-1.

Results: Treatment of CKD rats with Ca/P/VitD, but not normal animals, induced a significant increase in pulse pressure and PWV (p?de novo expression of osteocalcin was observed, whereas α-SMA immunofluorescence levels were reduced (p?p?Conclusion: This study indicate that smooth muscle cells differentiation to osteoblast-like cells and the associated media remodeling, which includes disruption of elastic lamellas and deposition of collagen are, at least in part, associated with the increased arterial stiffness observed in CKD rats with vascular calcification.     

正常人动态动脉僵硬指数随年龄的变化及与24 h脉压的相关性

目的 动态动脉僵硬指数(AASI)是新近提出的反映收缩压(SBP)和舒张压(DBP)之间动力学关系的一项指标,这项研究的主要目的是探讨正常人AASI随年龄的变化及其与24 h脉压(24 h PP)的相关性.方法 246名正常人[平均年龄(59.7±14.6)岁,女性占38.6%]在保持日常工作和生活起居的情况下配戴24 h动态血压监测(ABPM)仪,记录从早晨6:00到晚上22:00每间隔30min和从晚上22:00到第2天早晨6:00每问隔60 min的血压读数、心率(HR)、平均动脉压(MAP)及脉压(PP),然后按AASI=1-DBP对SBP的回归斜率计算每个个体的AASI值.结果 AASI随年龄的增大而增大.在正常人中,AASI的第95百分位数是0.56,其95%预测区间的上界在20～39岁时为0.49,40～59岁时为0.59,60～79岁时为0.69,≥80岁时为0.79.AASI与24 h PP呈正相关(r=0.497,P＜0.01).在正常人中,AASI随年龄的增长呈直线增加,而24 h PP随年龄增长呈曲线增加.结论 AASI作为反映血压关系的指标,其在正常人中表现为随年龄增大而增大的变化规律;与传统指标24 h PP相关,提示可作为预测动脉僵硬程度的新指标.     

No survival benefit from early‐start dialysis in a population‐based,inception cohort study of Swedish patients with chronic kidney disease

Abstract. Evans M., Tettamanti G., Nyrén O., Bellocco R., Fored C.M., Elinder C.‐G. (Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; University of Milano‐Bicocca, Milan, Italy; Karolinska Institutet, Stockholm, Sweden) No survival benefit from early‐start dialysis in a population‐based, inception cohort study of Swedish patients with chronic kidney disease. J Intern Med 2010; 269 : 289–298. Objective. To investigate how the timing of dialysis initiation is associated with mortality. Design. Population‐based, prospective, observational cohort study. Setting. Clinical laboratories (n = 69) provided information on all patients in Sweden whose serum creatinine level for the first time and exceeded 3.4 mg dL^?1 (men) or 2.8 mg dL^?1 (women) between 20 May 1996 and 31 May 1998. Subjects. All patients (n = 901), aged 18–74 years, in whom the cause of serum creatinine elevation was chronic kidney disease, were included in the study; participants were interviewed and followed for 5–7 years. Main outcome measures. Information on date of death was obtained from a national Swedish population register. Early‐start dialysis [estimated glomerular filtration rate from serum creatinine (eGFR) ≥7.5 mL min^?1 per 1.73 m²] was compared to late start of dialysis (eGFR <7.5 mL min^?1 per 1.73 m²), and no dialysis. Relative risk [hazard ratio (HR)] of death was modelled with time‐dependent multivariate Cox proportional hazards regression. Results. Mean eGFR was 16.1 mL min^?1 per 1.73 m² at inclusion and 7.6 mL min^?1 per 1.73 m² at the start of dialysis. Among the 385 patients who started dialysis late, 36% died during follow‐up compared to 52% of 323 who started early. The adjusted HR for death was 0.84 [95% confidence interval (CI) 0.64, 1.10] among late versus early starters. The mortality among nondialysed patients increased significantly at eGFR below 7.5 mL min^?1 per 1.73 m² (HR 4.65; 95% CI 2.28, 9.49; compared to eGFR 7.5–10 mL min^?1 per 1.73 m²). After the start of dialysis, the mortality rate further increased. Compared to nondialysed patients with eGFR ≤15 mL min^?1 per 1.73 m², adjusted HR was 2.65 (95% CI 1.80, 3.89) for patients receiving dialysis. Conclusion. We found no survival benefit from early initiation of dialysis.     

Evaluation of combined left ventricular function using the myocardial performance index in children with chronic kidney disease

Background: Myocardial dysfunction that complicates the initial stages of chronic kidney disease (CKD) has not been yet fully characterized in young patients. We aimed to assess the clinical usefulness of myocardial performance index obtained by pulsed‐wave Doppler method (PWD‐MPI) in predicting early disturbances of global left ventricular (LV) function in children with CKD stages 2–4. In addition, we evaluated the clinical utility of tissue Doppler imaging (TDI) as a tool for calculating MPI in comparison with the conventional method. Methods: Standard echocardiography was performed in 34 patients aged 3–18 years and for 35 age‐matched healthy control subjects. PWD‐MPI was calculated from Doppler spectra of mitral inflow and LV outflow. To obtain TDI‐MPI, time intervals were measured from mitral annulus. Results: The mean values of both PWD‐MPI and TDI‐MPI of the patients were significantly different from those of the control subjects. Using receiver operating characteristics curve analysis, TDI‐MPI yielded a better predictive discrimination for separating patients with versus those without myocardial dysfunction than PWD‐MPI. Using a PWD‐MPI >0.36 as the cutoff value, myocardial dysfunction was found with a sensitivity of 64.7% and specificity of 97%. The sensitivity and specificity of TDI‐MPI >0.34 in identification of LV dysfunction were 91% and 82%, respectively. TDI‐MPI was correlated with that measured by PWD (P < 0.004, r = 0.57). Conclusions: Subtle abnormalities of LV function develop early when renal insufficiency is mild to moderate. MPI, measuring by PWD and TDI, are appropriate indicators of overall LV function in young patients with CKD. (Echocardiography 2011;28:97‐103)     

Association of interarm blood pressure difference with cardio‐cerebral vascular disease: A community‐based,cross‐sectional study

Interarm blood pressure difference (IAD) is a risk factor for peripheral artery disease and cardio‐cerebral vascular disease (CCVD). The current study examines the association of IAD with stroke and coronary heart disease in a Chinese community. A cross‐sectional study was conducted in Pudong New Area in Shanghai, China. A total of 10 657 residents aged 15 years and older were randomly selected through three‐stage sampling. Volunteers had systolic and diastolic blood pressure (BP) measured in both arms at recruitment, and IAD was defined in both arms as the absolute difference in BP. Medical records of study participants were reviewed by investigators to confirm measurements. Logistic regression models were used to assess the association between systolic interarm blood pressure difference (sIAD) and diastolic interarm blood pressure difference (dIAD) with stroke and coronary heart disease. Compared with dIAD <5 mm Hg, the multivariate adjusted odds ratio (OR) of stroke prevalence was 1.357 (95% CI 0.725‐2.542, P = 0.034) for dIAD ≥20 mm Hg and 1.702 (95% CI1.025‐2.828, P = 0.040) for dIAD between 15 and 19 mm Hg, and the multivariate adjusted OR of coronary heart disease prevalence was 1.726 (95% CI 1.093‐2.726, P = 0.019) for dIAD ≥20 mm Hg and 1.498 (95% CI 0.993‐2.261, P = 0.044) for dIAD between 15 and 19 mm Hg. The relationship between cardio‐cerebral vascular disease and dIAD was significant in a Chinese community population. Further cohort studies are needed to investigate the association of different levels of IAD with the incidence of cardiovascular and cerebrovascular diseases and subsequent mortality.     

The role of disease severity in influencing body mass index in people with haemophilia: a single‐institutional cross‐sectional study

The aim of this study was to evaluate the effect of haemophilia disease severity and potential intermediaries on body mass index (BMI) in patients with haemophilia. A secondary analysis of a cross‐sectional study of 88 adults with haemophilia was undertaken. On bivariate analysis, persons with severe haemophilia had 9.8% lower BMI (95% CI ?17.1, ?3.0) than persons with non‐severe haemophilia. The effect of haemophilia severity on BMI varied significantly by human immunodeficiency virus (HIV) status. Among HIV‐positive subjects, haemophilia severity was not associated with BMI (+5.0%, 95% CI ?22.4, 41.9). Among HIV‐negative subjects, severe haemophilia was associated with 15.1% lower BMI (95% CI, ?23.6, ?5.7). Older (>41 years) HIV‐negative subjects with severe haemophilia had a BMI that was 24.8% lower (95% CI ?39.1, ?7.0) than those with non‐severe haemophilia. No statistically significant association was detected between BMI and severe vs. non‐severe haemophilia for younger HIV‐negative subjects. Although joint disease, as measured by the World Federation of Hemophilia (WFH) joint score, did not influence the association between haemophilia disease severity and BMI, adjustment for the atrophy component of the WFH score reduced the association between haemophilia severity and BMI by 39.1–69.9%. This suggested that muscle atrophy mediated at least part of the relationship between haemophilia severity and BMI. Haemophilia disease severity is associated with BMI and appears to be mediated by muscle atrophy of surrounding joints. This association appears to be modified by HIV status and possibly age.     

The effects of hypertension and diabetes on new‐onset chronic kidney disease: A prospective cohort study

The study aimed to determine the different status of hypertension and diabetes on the risk of new‐onset chronic kidney disease (CKD) events in Kailuan Study. A total of 21 905 individuals were enrolled in the study. The new‐onset incidents of CKD, hypertension, and diabetes were collected in the follow‐ups. All the individuals were divided into five groups according to baseline and follow‐up hypertension and diabetes status: baseline hypertension (BH), baseline hypertension and incidence of diabetes (BHID), baseline diabetes (BD), baseline diabetes and incidence of hypertension (BDIH), and baseline hypertension and diabetes (BHD). The risk of new‐onset CKD of the five groups was calculated using the Cox regression analysis. In the median follow‐up of 7.05 ± 2.59 years, the prevalence of new‐onset CKD in the group of BH, BHID, BD, BDIH, and BHD were 27.1, 43.79, 25.4, 36.6, and 45.1 per 1000 years, respectively. When adjusted possible confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) of new‐onset CKD were 1.50 (95% CI: 1.38‐1.63), 1.25(95% CI: 1.07‐1.47), and 1.52 (95% CI: 1.35‐1.7) in the group of BHID, BDIH, and BHD, respectively, as referred to the BH group (P < .001). No obvious difference was observed in the group of BH and BD for the incidence of new‐onset CKD. Sensitivity analysis still showed the similar results among the five groups. The study showed that the effect of simple hypertension or simple diabetes on new‐onset CKD was not significantly different, but the incidence of new‐onset hypertension or diabetes increased the risk of new‐onset CKD. Hypertension and diabetes had a synergistic influence on the risk of new‐onset CKD.