Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care / Evolución del estadio de la enfermedad renal crónica desde el diagnóstico de hipertensión arterial en atención primaria

Objective: To analyze the evolution of the stages of CKD and the progression of the estimation of glomerular filtration rate (eGFR) in patients with newly diagnosed hypertension. Design-: Retrospective cohort.SiteFamily Medicine Unit No. 31, Mexican Social Security Institute, Mexico City. Participants: Patients with hypertension who have been diagnosed in primary care and have developed chronic kidney disease .Main measurements: The eGFR was calculated with the CKD Epi formula in three moments, the first measurement was at the time of diagnosis of hypertension, the second measurement was made when it arrived a change in CKD stage and the last one at the end of the study, with which the evolution time from one stage to another was obtained, as well as the drop in eGFR. Results: The sample consisted of 207 electronic health records of patients, with an average follow-up of 10.2 years from the moment of diagnosis of hypertension until the end of the study. The average time to go from one baseline stage of CKD to another was 7 years (average decline in eGFR of 5.8ml/min/year) and to have a second stage change was 3.2 years (average decline in eGFR of 6.8ml/min/year), with a statistically significant repeated measures ANOVA (p<0.001). Conclusions: Patients with newly diagnosed hypertension remain longer in the initial stages of CKD, to later evolve and change more quickly.(AU)

Objetivo: Analizar la evolución de los estadios de la enfermedad renal crónica (ERC) y la progresión de la estimación de la tasa de filtración glomerular (eTFG) en pacientes con hipertensión arterial de nuevo diagnóstico. Diseño: Cohorte retrospectiva. Emplazamiento: Unidad de Medicina Familiar N.° 31, Instituto Mexicano del Seguro Social, Ciudad de México. Participantes: Pacientes hipertensos que hayan sido diagnosticados en atención primaria y hayan desarrollado ERC. Mediciones principales: La eTFG se calculó con la fórmula CKD Epi en 3 momentos. La primera medición fue al momento del diagnóstico de hipertensión arterial, la segunda medición se realizó cuando se presentó un cambio de estadio de la ERC y la última, al final del estudio, con el que se obtuvo el tiempo de evolución de un estadio a otro, así como el descenso de la eTFG. Resultados: La muestra estuvo constituida por 207 historias clínicas electrónicas de pacientes, con un seguimiento promedio de 10,2 años desde el momento del diagnóstico de hipertensión arterial hasta el final del estudio. El tiempo promedio para pasar de una etapa inicial de la ERC a otra fue de 7 años (disminución promedio de la eTFG de 5,8ml/min/año) y para tener un cambio de segunda etapa fue de 3,2 años (disminución promedio de la eTFG de 6,8ml/min/año), con un ANOVA de medidas repetidas estadísticamente significativo (p < 0,001). Conclusiones: Los pacientes con hipertensión arterial de nuevo diagnóstico permanecen más tiempo en los estadios iniciales de la ERC, para luego evolucionar y cambiar más rápidamente.(AU)

Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care.

OBJECTIVE: To analyze the evolution of the stages of CKD and the progression of the estimation of glomerular filtration rate (eGFR) in patients with newly diagnosed hypertension. DESIGN: Retrospective cohort. SITE: Family Medicine Unit No. 31, Mexican Social Security Institute, Mexico City. PARTICIPANTS: Patients with hypertension who have been diagnosed in primary care and have developed chronic kidney disease. MAIN MEASUREMENTS: The eGFR was calculated with the CKD Epi formula in three moments, the first measurement was at the time of diagnosis of hypertension, the second measurement was made when it arrived a change in CKD stage and the last one at the end of the study, with which the evolution time from one stage to another was obtained, as well as the drop in eGFR. RESULTS: The sample consisted of 207 electronic health records of patients, with an average follow-up of 10.2 years from the moment of diagnosis of hypertension until the end of the study. The average time to go from one baseline stage of CKD to another was 7 years (average decline in eGFR of 5.8ml/min/year) and to have a second stage change was 3.2 years (average decline in eGFR of 6.8ml/min/year), with a statistically significant repeated measures ANOVA (p<0.001). CONCLUSIONS: Patients with newly diagnosed hypertension remain longer in the initial stages of CKD, to later evolve and change more quickly.