TY - JOUR
T1 - Blood pressure and kidney outcomes in patients with severely decreased glomerular filtration rate
T2 - A nationwide observational cohort study
AU - Al-Sodany, Ehab
AU - Chesnaye, Nicholas C.
AU - Heimbürger, Olof
AU - Jager, Kitty J.
AU - Bárány, Peter
AU - Evans, Marie
N1 - Funding Information: Disclosures and funding: this study was supported by a grant from Stockholm City Council (ALF Medicine) and Center for Innovative Medicine (CIMED). Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Objectives:To investigate the association between blood pressure (BP) and kidney outcomes in patients with estimated glomerular filtration rate less than 30 ml/min per 1.73 m2and different degrees of albuminuria.Methods:National observational cohort study of 18 071 chronic kidney disease (CKD) stage 4-5 patients in routine nephrology care 2010-2017. The association between both baseline and repeated clinic office BP and eGFR slope and kidney replacement therapy (KRT) was explored using multivariable adjusted joint models. The analyses were stratified on albuminuria at baseline.Results:The adjusted yearly eGFR slope became increasingly steeper from -0,91 (95% CI -0.83 to -1.05) ml/min per 1.73 m2per year in those with SBP less than 120 mmHg at baseline to -2.09 (-1.83 to -2.37) ml/min per 1.73 m2in those with BP greater than 160 mmHg. Similarly, eGFR slope was steeper with higher DBP. Lower SBP and DBP was associated with slower eGFR decline in patients with albuminuria grade A3 (>30 mg/mmol) but not consistently in albuminuria A1-A2. Those with diabetes progressed faster and the association between BP and eGFR slope was stronger. In repeated BP measurement analyses, every 10 mmHg higher SBP over time was associated with 39% additional risk of KRT.Conclusion:In people with eGFR less than 30 ml/min per 1.73 m2, lower clinic office BP is associated with more favorable kidney outcomes. Our results support lower BP targets also in people with CKD stage 4-5.
AB - Objectives:To investigate the association between blood pressure (BP) and kidney outcomes in patients with estimated glomerular filtration rate less than 30 ml/min per 1.73 m2and different degrees of albuminuria.Methods:National observational cohort study of 18 071 chronic kidney disease (CKD) stage 4-5 patients in routine nephrology care 2010-2017. The association between both baseline and repeated clinic office BP and eGFR slope and kidney replacement therapy (KRT) was explored using multivariable adjusted joint models. The analyses were stratified on albuminuria at baseline.Results:The adjusted yearly eGFR slope became increasingly steeper from -0,91 (95% CI -0.83 to -1.05) ml/min per 1.73 m2per year in those with SBP less than 120 mmHg at baseline to -2.09 (-1.83 to -2.37) ml/min per 1.73 m2in those with BP greater than 160 mmHg. Similarly, eGFR slope was steeper with higher DBP. Lower SBP and DBP was associated with slower eGFR decline in patients with albuminuria grade A3 (>30 mg/mmol) but not consistently in albuminuria A1-A2. Those with diabetes progressed faster and the association between BP and eGFR slope was stronger. In repeated BP measurement analyses, every 10 mmHg higher SBP over time was associated with 39% additional risk of KRT.Conclusion:In people with eGFR less than 30 ml/min per 1.73 m2, lower clinic office BP is associated with more favorable kidney outcomes. Our results support lower BP targets also in people with CKD stage 4-5.
KW - albuminuria
KW - chronic kidney disease
KW - hypertension
KW - kidney replacement therapy
UR - http://www.scopus.com/inward/record.url?scp=85135209298&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/HJH.0000000000003168
DO - https://doi.org/10.1097/HJH.0000000000003168
M3 - Article
C2 - 35730420
SN - 0263-6352
VL - 40
SP - 1487
EP - 1498
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 8
ER -