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Time-Varying Association of Individual BP Components with eGFR in Late-Stage CKD
Manish M Sood1,2,3, Ayub Akbari1,4, Doug Manuel5,2,3,4
1Division of Nephrology.
Insights
In late-stage chronic kidney disease (CKD), extreme systolic and high diastolic blood pressure (BP) are linked to worsening kidney function. Pulse pressure did not show a significant association with estimated glomerular filtration rate (eGFR) decline.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- The relationship between specific blood pressure (BP) components and estimated glomerular filtration rate (eGFR) changes in advanced chronic kidney disease (CKD) remains unclear.
- Understanding these associations is crucial for managing patients with late-stage CKD.
Purpose of the Study:
- To investigate the associations of systolic BP, diastolic BP, and pulse pressure with continuous eGFR changes.
- To determine the relationship between BP components and a significant eGFR decline (≥30%) in late-stage CKD patients.
Main Methods:
- Retrospective cohort study of 1203 patients with CKD (eGFR≤30) from 2010-2015.
- General linear mixed models analyzed repeat BP measures and eGFR changes.
- Time-varying Cox models assessed BP components and risk of ≥30% eGFR decline.
Main Results:
- Systolic and diastolic BP measures over time significantly correlated with eGFR changes (P<0.001).
- Extremes in systolic BP (<105 or >170 mmHg) and high diastolic BP (>90 mmHg) were associated with increased risk of ≥30% eGFR decline.
- Pulse pressure was not significantly associated with eGFR changes or decline risk.
Conclusions:
- In patients with late-stage CKD referred to multidisciplinary care, only extreme systolic BP and elevated diastolic BP were linked to eGFR decline.
- These findings highlight the importance of controlling specific BP components in managing advanced CKD.
Background And Objectives:
The association of individual BP components with changes in eGFR in patients with late-stage CKD is unknown. The objectives of our study were to examine the associations of systolic BP, diastolic BP, and pulse pressure with continuous temporal changes in eGFR and an eGFR decline ≥30% in late-stage CKD.
Design, Setting, Participants, & Measurements:
We performed a retrospective cohort study (2010-2015) of patients with CKD in a multidisciplinary CKD clinic with an eGFR≤30. The associations of repeat measures of BP (systolic BP, diastolic BP, and pulse pressure) with eGFR were examined using general linear mixed models. The associations of BP components and eGFR decline ≥30% were examined with time-varying Cox models.
Results:
In total, 1203 patients were followed for a median of 548 days (interquartile range, 292-913), with an average of 6.7 visits and BP measures per patient. Mean baseline systolic BP, diastolic BP, pulse pressure, and eGFR were 139.2 mmHg, 73.2 mmHg, 64.9 mmHg, and 16.8 ml/min, respectively. Systolic BP and diastolic BP measures over time were statistically significantly associated with changes in eGFR (P<0.001), whereas pulse pressure was not. Patients with extremes of systolic BP (<105 or >170) and high diastolic BP (>90) measures were at a higher risk of GFR decline ≥30% (systolic BP <105: hazard ratio, 1.51; 95% confidence interval, 0.98 to 2.34; systolic BP >170: hazard ratio, 1.62; 95% confidence interval, 1.05 to 2.49; referent systolic BP =121-130; diastolic BP =81-90: hazard ratio, 1.40; 95% confidence interval, 0.99 to 1.86; diastolic BP >90: hazard ratio, 1.83; 95% confidence interval, 1.21 to 2.77; referent diastolic BP =61-70). The findings were consistent after multiple sensitivity analyses. Pulse pressure was not significantly associated with risk of eGFR decline.
Conclusions:
In patients referred to a multidisciplinary care clinic with late-stage CKD, only extremes of systolic BP and elevations of diastolic BP were associated with eGFR decline.