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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association of Blood Pressure With the Progression of CKD: Findings From KNOW-CKD Study
Jee Young Lee1, Jung Tak Park1, Young Su Joo1
1Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
Insights
Higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) are linked to increased risk of kidney disease progression in patients with chronic kidney disease (CKD). SBP showed a stronger association with adverse kidney outcomes than DBP.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Epidemiology
Background:
- Optimal blood pressure (BP) management is crucial for slowing chronic kidney disease (CKD) progression.
- Understanding the specific impact of BP levels on kidney outcomes is essential for refining treatment strategies.
Purpose of the Study:
- To investigate the association between baseline and time-updated BP levels and adverse kidney outcomes in a Korean cohort with CKD.
- To determine whether systolic BP (SBP) or diastolic BP (DBP) has a stronger impact on CKD progression.
Main Methods:
- A prospective observational cohort study involving 2,044 participants from the Korean Cohort Study for Outcomes in Patients With CKD (KNOW-CKD).
- Analysis of baseline and time-updated SBP and DBP using multivariate cause-specific hazards models and marginal structural models.
- The composite kidney outcome included a ≥50% decline in estimated glomerular filtration rate (eGFR) or incident kidney replacement therapy.
Main Results:
- Higher baseline and time-updated SBP levels were significantly associated with an increased risk of the composite kidney outcome.
- Time-updated DBP, but not baseline DBP, showed a significant association with adverse kidney outcomes.
- Higher SBP levels correlated with steeper eGFR decline slopes, and SBP demonstrated a stronger association with kidney outcomes than DBP.
Conclusions:
- Elevated SBP and DBP are associated with a higher risk of CKD progression.
- SBP plays a more significant role in driving adverse kidney outcomes compared to DBP in patients with CKD.
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.
Study Design:
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.
Analytical Approach:
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.
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