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Intensive blood pressure control and the progression of IgA nephropathy: a cohort study using marginal structural

Chen Tang1,2,3, Pei Chen1,2,3, Feng-Lei Si1,2,3

  • 1Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|June 30, 2023
PubMed

Insights

Intensive blood pressure control in IgA nephropathy may slow kidney disease progression. However, the study found a U-shaped association, indicating risks with both very low and high systolic blood pressure.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Research

Background:

  • Current chronic kidney disease guidelines recommend systolic blood pressure (SBP) below 120 mmHg.
  • The renoprotective effect of intensive blood pressure (BP) lowering in immunoglobulin A nephropathy (IgAN) is not well-established.
  • This study investigates the impact of intensive BP control on IgAN progression.

Purpose of the Study:

  • To determine the effect of intensive BP control on the progression of IgAN.
  • To analyze the relationship between baseline and time-updated BP and kidney outcomes in IgAN patients.

Main Methods:

  • 1530 IgAN patients were enrolled at Peking University First Hospital.
  • Composite kidney outcomes were defined as end-stage kidney disease (ESKD) or a 30% decline in estimated glomerular filtration rate (eGFR).
  • Multivariate causal hazards models and marginal structural models (MSMs) were used to analyze baseline and time-updated BP data.

Main Results:

  • A U-shaped association was observed between time-updated SBP and composite kidney outcomes.
  • Compared to SBP 110-119 mmHg, SBP <110 mmHg (HR 1.48) and SBP ≥140 mmHg (HR 2.91) increased risk.
  • The trend was more pronounced in patients with proteinuria ≥1 g/day and eGFR ≥60 mL/min/1.73 m2; no similar trend was found for diastolic BP.

Conclusions:

  • Intensive BP control during treatment may slow kidney disease progression in IgAN patients.
  • A U-shaped relationship exists for SBP, suggesting risks at both low and high levels.
  • The potential risk of hypotension requires careful consideration in managing IgAN patients.
Abstract

Keywords:
IgA nephropathyintensive blood pressure controlkidney disease progressiontime-updated BP

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