[Predictors of chronic kidney disease in hypertensive patients]

Actual European guidelines for the management of arterial hypertension (AH) have recognized the importance of renal function impairment on long-term prognosis in patients with this condition. Chronic kidney disease (CKD) is defined as glomerular filtration rate (GFR) below 60 ml/min/1.73 m2 and is associated with increased risk of cardiovascular events particularly among patients with AH. The aim of the study was to evaluate the predictors for CKD in patients with AH.

The study was performed in 748 consecutive hospitalized patients with diagnosed and treated essential AH. We estimated GFR using abbreviated Modification of Diet in Renal Disease (MDRD) equation and assessed relationship between clinical and laboratory parameters with GFR below 60 ml/min/1.73 m2 (analysis of variance and logistic regression analysis).

According to estimated GFR using the MDRD formula, CKD (GFR below 60 ml/min/ 1.73 m2) was found in 314 patients (42%). Patients with CKD were significantly more likely to be older, to have atherogenic dyslipidemia and clinical manifestations of atherosclerosis (coronary heart disease, prior myocardial infarction and cerebral atherosclerosis). Women more likely (71%) fulfilled criteria for CKD. Independent predictors of GFR value below 60 ml/min/1.73 m2 (CKD) were: age > 65 years, woman gender and atherogenic dyslipidaemia, there was a trend for clinical manifestations of atherosclerosis (p = 0.079).

CKD is present in about 40% of patients with AH. Simple clinical parameters (age > 65 years, female gender, atherogenic dyslipidemia, clinical manifestations of atherosclerosis) are predictors of the prevalence of this serious complication of AH which is characterized by high cardiovascular risk. More frequent estimation of GFR in clinical practice will allow to identify this population of patients earlier.