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Published on: October 26, 2020
Higher plasma renin activity is associated with increased kidney damage risk in patients with hypertension and
Mengyue Lin1, Mulalibieke Heizhati1, Lin Gan1
1Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute; National Health Committee, Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China.
Insights
Higher plasma renin activity (PRA) significantly increases kidney damage risk in hypertensive patients with glucose metabolic disorders (GMD). This finding highlights PRA as a crucial predictor for kidney disease progression in this high-risk population.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- The role of renin in kidney damage among hypertensive patients with glucose metabolic disorders (GMD) is not fully understood.
- Hypertension and GMD are significant risk factors for chronic kidney disease (CKD).
- Plasma renin activity (PRA) is a key component of the renin-angiotensin-aldosterone system.
Purpose of the Study:
- To investigate the association between plasma renin activity (PRA) and the development of kidney damage in hypertensive patients with GMD.
- To identify PRA as a potential predictor of incident chronic kidney disease (CKD) in this specific patient cohort.
Main Methods:
- A cohort of 2033 hypertensive inpatients with GMD, free of CKD at baseline, was analyzed.
- Kidney damage was assessed using estimated glomerular filtration rate (eGFR) and urine protein levels.
- Plasma renin activity (PRA) was measured and analyzed as both a continuous variable and dichotomized into high (≥0.65) and low (<0.65) groups.
- Multivariable Cox regression models were used to evaluate the association between PRA and incident CKD, controlling for relevant covariates.
Main Results:
- During a median follow-up of 31 months, 291 participants developed CKD.
- The incidence of CKD was significantly higher in the high-PRA group compared to the low-PRA group (54.6 vs 36.6 per 1000 person-years).
- Higher PRA was independently associated with an increased risk of incident CKD, particularly proteinuria (HR=1.784 for high vs low PRA; P=0.001).
- Nonlinear associations were observed between PRA levels and the risk of kidney damage.
Conclusions:
- Elevated plasma renin activity (PRA) is a significant predictor of incident kidney damage, especially proteinuria, in hypertensive patients with glucose metabolic disorders (GMD).
- These findings suggest that PRA measurement may be valuable for risk stratification in patients with coexisting hypertension and diabetes.
- The association between higher PRA and kidney damage is independent of aldosterone levels.
Abstract:
The impact of renin on kidney remain unclear among hypertensives with glucose metabolic disorders (GMD). We aimed to evaluate the association between plasma renin activity (PRA) and kidney damage in hypertensive patients with GMD. Overall, 2033 inpatients with hypertension and GMD free of chronic kidney disease (CKD) at baseline were included. CKD was defined using estimated glomerular filtration rate (eGFR) and urine protein. PRA was treated as continuous variable, and also dichotomized as high (≥0.65) or low (< 0.65) groups. The association of PRA with incident CKD was evaluated using multivariable Cox model controlling for antihypertensive medications and baseline aldosterone, and traditional parameters. Subgroup and interaction analyses were performed to evaluate heterogeneity. During a median follow-up of 31 months, 291 participants developed CKD. The incidence was higher in high-renin group than that in low-renin group (54.6 vs 36.6/1000 person-years). Significant association was observed between PRA and incident CKD, and the association was mainly driven by an increased risk for proteinuria. Each standard deviation increment in log-transformed PRA was associated with 16.7% increased risk of proteinuria (hazard ratio = 1.167, P = .03); compared with low-renin group, there was 78.4% increased risk for high-renin group (hazard ratio = 1.784, P = .001). Nonlinear associations were observed between PRA and kidney damage. Higher PRA is associated with greater risk of incident kidney damage, especially for positive proteinuria, in patients with coexistence of hypertension and diabetes, independent of aldosterone. In this patient population with high risk for kidney damage, PRA may serve as an important predictor.
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