Protecting Renal Function in Chronic Kidney Disease Patients with Isolated Nighttime Hypertension

Inclusion criteria

• Participants must be 18 years of age or older. All genders are eligible;
• Confirmed diagnosis of Chronic Kidney Disease (CKD) according to KDIGO. guidelines;
• UACR < 30 mg/g (3.4 mg/mmol) and eGFR between 20-44 mL/min/1.73 m²; or UACR between 30-300 mg/g (3.4-33.9 mg/mmol) and eGFR between 20-59 mL/min/1.73 m²; or UACR between 300-5000 mg/g (33.9-565 mg/mmol) and eGFR > 20 mL/min/1.73 m² (CKD-EPI equation).
• Office blood pressure measurements below 140/90 mmHg at both screening visits;
• Daytime ambulatory blood pressure < 135/85 mmHg and nighttime systolic blood pressure ≥ 120 mmHg or diastolic blood pressure ≥ 70 mmHg;
• No use of corticosteroids, immunosuppressants, or biologic agents for at least one month prior to enrollment;

Exclusion criteria

• Presence of acute kidney injury or acute renal failure;
• History of kidney transplantation;
• Presence of severe arrhythmias, including severe atrial fibrillation, atrioventricular (AV) block, sinoatrial (SA) block, sinus bradycardia, malignant AV node reentrant tachycardia syndrome;
• Secondary hypertension related to suspected or confirmed renal artery stenosis or adrenal gland disorders;
• Poor glycemic control (HbA1c > 12%);
• Orthostatic hypotension (a decrease in blood pressure of >20/10 mmHg within 3 minutes of standing from a sitting position);
• Women who are pregnant or breastfeeding at the time of enrollment, or not employing contraception of reproductive age;
• NYHA (New York Heart Association) Class III-IV congestive heart failure at the time of enrollment;
• History of myocardial infarction, unstable angina, acute heart failure, stroke, transient ischemic attack (TIA), or cerebral hemorrhage within the 12 weeks prior to enrollment;
• Underwent coronary revascularization (Percutaneous Coronary Intervention [PCI] or Coronary Artery Bypass Grafting [CABG]), or valve repair/replacement within the 12 weeks prior to enrollment, or planned to undergo any of the aforementioned surgical procedures after randomization;
• Any other serious diseases outside the renal and cardiovascular domains, including but not limited to malignancies, with an expected survival of less than 2 years based on the investigator's clinical judgment;
• Presence of active malignancy requiring pharmacological treatment;
• AST (Aspartate Aminotransferase) or ALT (Alanine Aminotransferase) levels >3 times the upper limit of normal (ULN);
• Total bilirubin >2 times ULN. Patients with Gilbert's syndrome who exhibit isolated bilirubin elevation do not need to be excluded;