Association of Blood Pressure With the Progression of CKD: Findings From KNOW-CKD Study.
Am J Kidney Dis
; 78(2): 236-245, 2021 08.
Article
em En
| MEDLINE
| ID: mdl-33444666
ABSTRACT
RATIONALE & OBJECTIVE:
Optimal blood pressure (BP) control is a major therapeutic strategy in the management of chronic kidney disease (CKD). We studied the association between BP and adverse kidney outcomes within a diverse cohort of Koreans with CKD. STUDYDESIGN:
Prospective observational cohort study. SETTING &PARTICIPANTS:
2,044 participants from the Korean Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). EXPOSURES Baseline and time-updated systolic BP (SBP) and diastolic BP (DBP).OUTCOME:
A composite kidney outcome of a≥50% decline in estimated glomerular filtration rate (eGFR) from the baseline value or incident kidney replacement therapy. ANALYTICALAPPROACH:
Multivariate cause-specific hazards models and marginal structural models were fitted for baseline and time-updated BP, respectively.RESULTS:
During 7,472 person-years of follow-up, the primary composite kidney outcome occurred in 473 participants (23.1%), an incidence rate of 63.3 per 1,000 patient-years. Compared with baseline SBP<120mm Hg, the hazard ratios (HRs) for 120-129, 130-139, and≥140mm Hg were 1.10 (95% CI, 0.83-1.44), 1.20 (95% CI, 0.93-1.59), and 1.43 (95% CI, 1.07-1.91), respectively. This association was more evident in the model with time-updated SBP, for which the corresponding HRs were 1.31 (95% CI, 0.98-1.75), 1.59 (95% CI, 1.16-2.16), and 2.29 (95% CI, 1.69-3.11), respectively. In the analyses of DBP, we observed that time-updated DBP but not baseline DBP was significantly associated with the composite kidney outcome. Compared to patients with SBP<120mm Hg, patients with higher SBP had steeper slopes of eGFR decline. In the model including both SBP and DBP, only SBP was significantly associated with the composite kidney outcome.LIMITATIONS:
Observational design, unmeasured confounders, and use of office BPs only.CONCLUSIONS:
In patients with CKD, higher SBP and DBP levels were associated with a higher risk of a composite kidney outcome reflecting CKD progression. SBP had a greater association with adverse kidney outcomes than DBP.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Pressão Sanguínea
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Insuficiência Renal Crônica
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Hipertensão
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article