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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
The association of SBP with mortality in patients with stage 1-4 chronic kidney disease
Min Zhuo1, Danwen Yang, Alexander Goldfarb-Rumyantzev
1Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Optimal blood pressure for chronic kidney disease (CKD) patients is between 100-120 mmHg. Systolic blood pressure (SBP) below 100 mmHg or above 120 mmHg is linked to increased mortality in CKD stages 1-4.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Public Health
Background:
- Hypertension is a known risk factor for chronic kidney disease (CKD) progression and mortality.
- The optimal systolic blood pressure (SBP) target for reducing mortality in CKD patients across different stages remains unclear.
Purpose of the Study:
- To determine the optimal SBP range associated with decreased all-cause mortality in individuals with CKD stages 1-4.
- To identify SBP thresholds linked to increased mortality risk in CKD patients.
Main Methods:
- Retrospective cohort study of 13,414 individuals with CKD stages 1-4 from NHANES datasets (1999-2004).
- Follow-up until December 31, 2010.
- Multivariate analysis and Kaplan-Meier curves used to assess SBP and mortality risk factors.
Main Results:
- SBP < 100 mmHg was associated with significantly increased mortality in CKD stages 2-4.
- Higher SBP, as a continuous variable, was linked to increased mortality risk in patients on or not on antihypertensive medication.
- In patients on antihypertensive medication, SBP < 100 mmHg or > 120 mmHg was associated with increased mortality risk.
Conclusions:
- SBP divergence above 120 mmHg or below 100 mmHg is associated with higher all-cause mortality in CKD stages 1-4, particularly in those on antihypertensive medication.
- Findings support an optimal target SBP range of 100-120 mmHg for CKD patients stages 1-4.
Objectives:
Hypertension is a risk factor for chronic kidney disease (CKD) progression and mortality. However, the optimal blood pressure associated with decreased mortality in each stage of CKD remains uncertain.
Methods:
In this retrospective cohort study, we included 13 414 individuals with CKD stages 1-4 from NHANES general population datasets from 1999 to 2004 followed to 31 December 2010. Multivariate analysis and Kaplan--Meier curves were used to assess SBP and risk factors associated with overall mortality in each CKD stage.
Results:
In these individuals with death rates of 9, 12, 30 and 54% in baseline CKD stages 1 through 4, respectively, SBP less than 100 mmHg was associated with significantly increased mortality adjusted for age, sex and race in stages 2,3,4. After excluding less than 100 mmHg, as a continuous variable, higher SBP is associated with fully adjusted increased mortality risk in those on or not on antihypertensive medication (hazard ratio 1.006, P = 0.0006 and hazard ratio 1.006 per mmHg, P < 0.0001, respectively). In those on antihypertensive medication, SBP less than 100 mmHg or in each 20 mmHg categorical group more than 120 mmHg is associated with an adjusted risk of increased mortality. Increasing age, men, smoking, diabetes and comorbidities are associated with increased mortality risk.
Conclusion:
For patients with CKD stages 1-4, the divergence of SBP above or below 100-120 mmHg was found to be associated with higher all-cause mortality, especially in those patients on antihypertensive medication. These findings support the recent guideline of an optimal target goal SBP of 100-120 mmHg in patients with CKD stages 1-4.
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