scholarly journals Association of blood pressure and renal outcome in patients with chronic kidney disease; a post hoc analysis of FROM-J study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mariko Tsuchida-Nishiwaki ◽  
Haruhito A. Uchida ◽  
Hidemi Takeuchi ◽  
Noriyuki Nishiwaki ◽  
Yohei Maeshima ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Outcome ◽  
Ckd Progression ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

AbstractIt is well-known that hypertension exacerbates chronic kidney disease (CKD) progression, however, the optimal target blood pressure (BP) level in patients with CKD remains unclear. This study aimed to assess the optimal BP level for preventing CKD progression. The risk of renal outcome among different BP categories at baseline as well as 1 year after, were evaluated using individual CKD patient data aged between 40 and 74 years from FROM-J [Frontier of Renal Outcome Modifications in Japan] study. The renal outcome was defined as ≥ 40% reduction in estimated glomerular filtration rate to < 60 mL/min/1.73 m2, or a diagnosis of end stage renal disease. Regarding baseline BP, the group of systolic BP (SBP) 120–129 mmHg had the lowest risk of the renal outcome, which increased more than 60% in SBP ≥ 130 mmHg group. A significant increase in the renal outcome was found only in the group of diastolic BP ≥ 90 mmHg. The group of BP < 130/80 mmHg had a benefit for lowering the risk regardless of the presence of proteinuria, and it significantly reduced the risk in patients with proteinuria. Achieving SBP level < 130 mmHg after one year resulted in a 42% risk reduction in patients with SBP level ≥ 130 mmHg at baseline. Targeting SBP level < 130 mmHg would be associated with the preferable renal outcome.Clinical Trial Registration-URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000001159 (16/05/2008).

Effect of intensive blood pressure on the progression of non-diabetic chronic kidney disease at varying degrees of proteinuria

2021 ◽  
pp. jim-2020-001702
Author(s):  
Paul J Der Mesropian ◽  
Gulvahid Shaikh ◽  
Kelly H Beers ◽  
Swati Mehta ◽  
Mauricio R Monrroy Prado ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pooled Analysis ◽  
Ckd Progression ◽  
Glomerular Filtration Rate Decline ◽  
Multivariable Regression ◽  
Stage Renal Disease ◽  
End Stage

The ideal blood pressure (BP) target for renoprotection is uncertain in patients with non-diabetic chronic kidney disease (CKD), especially considering the influence exerted by pre-existing proteinuria. In this pooled analysis of landmark trials, we coalesced individual data from 5001 such subjects randomized to intensive versus standard BP targets. We employed multivariable regression to evaluate the relationship between follow-up systolic blood pressure (SBP) and diastolic blood pressure (DBP) on CKD progression (defined as glomerular filtration rate decline by 50% or end-stage renal disease), focusing on the potential for effect modification by baseline proteinuria or albuminuria. The median follow-up was 3.2 years. We found that SBP rather than DBP was the primary predictor of renal outcomes. The optimal SBP target was 110–129 mm Hg. We observed a strong interaction between SBP and proteinuria such that lower SBP ranges were significantly linked with progressively lower CKD risk in grade A3 albuminuria or ≥0.5–1 g/day proteinuria (relative to SBP 110–119 mm Hg, the adjusted HR for SBP 120–129 mm Hg, 130–139 mm Hg, and 140–149 mm Hg was 1.5, 2.3, and 3.3, respectively; all p<0.05). In grade A2 microalbuminuria or proteinuria near 0.5 g/day, a non-significant but possible connection was seen between tighter BP and decreased CKD (aforementioned HRs all <2; all p>0.05), while in grade A1 albuminuria or proteinuria <0.2 g/day no significant association was apparent (HRs all <1.5; all p>0.1). We conclude that in non-diabetic CKD, stricter BP targets <130 mm Hg may help limit CKD progression as proteinuria rises.

Abstract MP30: Chronic Kidney Disease Progression and Risk of End-Stage Renal Disease: The Use of Change in Novel Kidney Filtration Markers

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Casey M Rebholz ◽  
Kunihiro Matsushita ◽  
Elizabeth Selvin ◽  
Morgan E Grams ◽  
Josef Coresh
Keyword(s):  
Chronic Kidney Disease ◽  
Clinical Trials ◽  
Kidney Disease ◽  
Cystatin C ◽  
End Stage Renal Disease ◽  
Ckd Progression ◽  
Percent Change ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Chronic kidney disease (CKD) progression assessed by estimated GFR from creatinine (eGFR-Cr) is a risk factor for cardiovascular disease and end-stage renal disease (ESRD) and has been proposed as a surrogate endpoint for clinical trials. It is unclear if CKD progression assessed by change in different filtration markers has similar risk associations with ESRD. Hypothesis: We hypothesized that percent change in novel kidney filtration markers (β 2 -microglobulin and cystatin C) over a 6-year period would be independently associated with increased risk of ESRD during 15 years of follow-up, similar to the risk seen with change in eGFR-Cr. Methods: We conducted prospective analyses of the ARIC study (N=9,703). β 2 -microglobulin, cystatin C, and creatinine were measured at study visits 1 (1990-92) and 2 (1996-98). Incident ESRD (kidney dialysis or transplant) was defined as entry into the U.S. Renal Data System registry between study visit 2 and September 30, 2011. Cox proportional hazards regression was used to estimate the association between percent change in filtration marker and incident ESRD, adjusting for demographics, kidney disease risk factors, and 1 st measurement of the filtration marker. Results: During a median follow-up of 13.1 years, there were 142 incident ESRD cases. Median eGFR-Cr was 97.3 mL/min/1.73 m 2 at 1 st measurement and 89.0 mL/min/1.73 m 2 at 2 nd measurement. Percent change in eGFR-Cr was moderately correlated with percent change in the inverse of β 2 -microglobulin (r = 0.34) and the inverse of cystatin C (r = 0.36). Progression of CKD (10-25% and >25% decline in filtration function) was associated with increased ESRD risk, with novel markers (β 2 -microglobulin, cystatin C) showing an association at least as strong as the creatinine and eGFR-Cr estimates (Table). Conclusions: CKD progression assessed using novel filtration markers is independently associated with ESRD risk, suggesting the potential utility of measuring change in β 2 -microglobulin and cystatin C in clinical trials.

scholarly journals Effect of Arteriovenous Fistula Creation on Systolic and Diastolic Blood Pressure in Patients With Pre-dialysis Advanced Chronic Kidney Disease

2019 ◽  
Vol 32 (9) ◽  
pp. 858-867 ◽  
Author(s):  
Roy O Mathew ◽  
Jerome Fleg ◽  
Janani Rangaswami ◽  
Bo Cai ◽  
Arif Asif ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Treatment Resistant ◽  
Advanced Chronic Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage

AbstractBACKGROUNDCentral arteriovenous fistula (cAVF) has been investigated as a therapeutic measure for treatment-resistant hypertension in patients without advanced chronic kidney disease (CKD). There is considerable experience with the use of AVF for hemodialysis in patients with end-stage renal disease (ESRD). However, there is sparse data on the blood pressure (BP) effects of an AVF among patients with ESRD. We hypothesized that AVF creation would significantly reduce BP compared with patients who did not have an AVF among patients with ESRD before starting hemodialysis.METHODSBPs were compared during the 12 months before hemodialysis initiation in 399 patients with an AVF or AV graft created and 4,696 patients without either.RESULTSAfter propensity score matching 1:2 ratio (AVF to no AVF), repeated measures analysis of variance revealed significant reductions of –1.7 mm Hg systolic and –3.9 mm Hg diastolic BP 12 months in patients after AVF creation; P = 0.025 and P &lt; 0.001, respectively, compared with those with no AVF.CONCLUSIONSThese findings suggest that AVF creation results in modest BP reduction in patients with pre-dialysis ESRD who require AVF for eventual hemodialysis therapy. Preferential diastolic BP reduction suggests that greater work is needed to characterize the ideal patient subset in which to use cAVF for treatment-resistant hypertension in those without advanced CKD.

scholarly journals Blood Pressure Components and End-stage Renal Disease in Persons With Chronic Kidney Disease

2012 ◽  
Vol 172 (1) ◽  
pp. 41 ◽  
Author(s):  
Carmen A. Peralta ◽  
Keith C. Norris ◽  
Suying Li ◽  
Tara I. Chang ◽  
Manjula K. Tamura ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Effects of Prevalent and Incident Atrial Fibrillation on Renal Outcome, Cardiovascular Events, and Mortality in Patients with Chronic Kidney Disease

2019 ◽  
Vol 8 (9) ◽  
pp. 1378 ◽  
Author(s):  
Hsin-Hui Hsu ◽  
Chew-Teng Kor ◽  
Yao-Peng Hsieh ◽  
Ping-Fang Chiu
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
End Stage Renal Disease ◽  
Renal Outcome ◽  
Research Database ◽  
All Cause Mortality ◽  
Clinical Consequences ◽  
Stage Renal Disease ◽  
End Stage

Background: Little is known about how incident atrial fibrillation (AF) affects the clinical outcomes in chronic kidney disease (CKD) patients and whether there is a different influence between pre-existing and incident AF. Methods: Incident CKD patients from 2000 to 2013 were retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan and they were classified as non-AF (n = 15,251), prevalent AF (n = 612), and incident AF (n = 588). The outcomes of interest were end-stage renal disease (ESRD) requiring dialysis, all-cause mortality, cardiovascular (CV) mortality, acute myocardial infarction (AMI), stroke or systemic thromboembolism. Results: Compared with CKD patients without AF, those with prevalent or incident AF were associated with higher adjusted rates of ESRD (hazard ratio (HR), 1.40; 95% confidence interval (CI), 1.32–1.48; HR, 2.91; 95% CI, 2.74–3.09, respectively), stroke or systemic thromboembolism (HR, 1.89; 95% CI, 1.77–2.03; HR, 1.67; 95% CI, 1.54–1.81, respectively), AMI (HR, 1.24; 95% CI, 1.09–1.41; HR, 1.99; 95% CI, 1.75–2.27, respectively), all-cause mortality (HR, 1.64; 95% CI, 1.56–1.72; HR, 2.17; 95% CI, 2.06–2.29, respectively), and CV mortality (HR, 2.95; 95% CI, 2.62–3.32; HR, 4.61; 95% CI, 4.09–5.20, respectively). Intriguingly, CKD patients with prevalent AF were associated with lower adjusted rates of ESRD, AMI, all-cause mortality, and CV mortality compared with those with incident AF. Conclusion: Both incident and prevalent AF were independently associated with greater risks of AMI, all-cause mortality, CV mortality, ESRD, and stroke or systemic thromboembolism. Our findings are novel in that, compared with prevalent AF, incident AF possessed an even higher risk of some clinical consequences, including ESRD, all-cause mortality, CV mortality, and AMI.

Abstract P019: Association Between Hypertension and Kidney Function Trajectory: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Casey M Rebholz ◽  
Yuan Chen ◽  
Kunihiro Matsushita ◽  
Josef Coresh ◽  
Morgan E Grams
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Hypertension Status ◽  
Atherosclerosis Risk In Communities ◽  
Stage Renal Disease ◽  
End Stage ◽  
Study Participants ◽  
Kidney Function Decline

Introduction: Cardiovascular disease, including hypertension, increases the risk of kidney disease progression. The relationship between hypertension and change in kidney function has not been fully elucidated. We hypothesized that hypertension is associated with faster kidney function decline. Methods: Hypertension status was assessed among Atherosclerosis Risk in Communities (ARIC) Study participants at baseline (1987-89) and defined as systolic blood pressure ≥140, diastolic blood pressure ≥90, or anti-hypertensive medication use in the last two weeks. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) was calculated using creatinine measured at baseline and follow-up study visits (1990-92; 1996-98; 2011-13) and an eGFR value of 15 mL/min/1.73 m 2 was imputed for incident end-stage renal disease cases. Results: After excluding those with missing baseline measurements of blood pressure, missing serum creatinine, and prevalent end-stage renal disease, there were 15,622 study participants. Baseline mean age was 55 years, 55% were female, 26% were black, and 35% had hypertension. Mean annual eGFR decline was 1.98 mL/min/1.73 m 2 per year among those with hypertension and 1.54 mL/min/1.73 m 2 per year among those without hypertension, after adjusting for demographic characteristics and co-morbidities (Figure, p<0.001). Participants with hypertension at baseline were more likely to develop chronic kidney disease than those without hypertension. Over 25 years, for those with hypertension and those without hypertension, respectively, the probability of developing chronic kidney disease stage 3A (eGFR <60 mL/min/1.73 m 2 ) was 55.3% and 44.5%, stage 3B (eGFR <45 mL/min/1.73 m 2 ) was 24.3% and 19.1%, stage 4 (eGFR <30 mL/min/1.73 m 2 ) was 9.2% and 7.7%, and stage 5 (eGFR <15 mL/min/1.73 m 2 ) was 3.9% and 3.5%. Conclusion: Hypertension status was associated with faster kidney function decline. Absolute risk increase was greater for earlier kidney disease stages.

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