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[Influence of blood pressure on the progression rate of advanced chronic renal insufficiency]
T Hannedouche1, P Chauveau, A Ferhat
1Département de néphrologie, hôpital Necker, Paris, France.
Insights
Systemic arterial pressure minimally impacts advanced chronic renal failure (CRF) progression. However, lower mean arterial pressure (MAP) may accelerate CRF in patients with chronic interstitial nephritis.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Internal Medicine
Context:
- The impact of systemic arterial pressure on chronic renal failure (CRF) progression remains debated.
- Understanding factors influencing CRF progression is crucial for patient management.
Purpose:
- To investigate the influence of mean arterial pressure (MAP) on the rate of renal function decline in patients with advanced CRF.
- To analyze the relationship between MAP and the time to initiating hemodialysis.
Summary:
- A retrospective analysis of 167 advanced CRF patients examined the correlation between MAP and the time from plasma creatinine 500 µmol/l to hemodialysis (500-HD).
- Overall, a weak negative correlation was found between MAP and 500-HD (r = -0.20, p < 0.02).
- A significant negative correlation was observed in chronic interstitial nephritis patients (r = -0.47, p < 0.002), and patients with MAP ≤ 95 mmHg had a longer 500-HD interval (24.7 vs. 14.7 months, p < 0.001).
Impact:
- Findings suggest MAP is not a primary determinant of advanced CRF progression.
- MAP may influence CRF progression in specific subgroups, particularly those with chronic interstitial nephritis or very low MAP.
- Results may inform clinical strategies for managing blood pressure in advanced CRF patients.
Abstract:
Influence of systemic arterial pressure on the progression rate of renal function in patients with advanced CRF is still controversial. In a retrospective analysis of 167 patients with well-characterized primitive nephropathy, we analyzed the influence of mean arterial pressure (MAP), either treated or untreated, on the progression rate of CRF as judged by the time interval elapsed between plasma creatinine 500 mumol/l and first iterative hemodialysis (500-HD). In the whole group, mean 500-HD interval was 15.5 +/- 10.5 months (mean +/- SD). Linear regression analysis showed a weak correlation between MAP and 500-HD (r = -0.20; p less than 0.02). Significant correlation could not be found in subgroup analysis of patients with chronic glomerulonephritis (n = 68), angionephrosclerosis (n = 22), or polycystic kidney disease (n = 35). A significant negative correlation between MAP and 500-HD was demonstrated in the subgroup of 42 patients with chronic interstitial nephritis (r = -0.47; p less than 0.002). Stratification analysis according to MAP values did not reveal significant differences in 500-HD interval except for the patients with MAP less than or equal to 95 mmHg whose 500-HD was 24.7 +/- 18.4 months versus 14.7 +/- 9.0 months in patients with MAP greater than 95 mmHg (p less than 0.001). These results suggest that MAP may not be a determinant factor in the progression rate of advanced CRF, except possibly for patients with chronic interstitial nephritis and/or very low MAP.