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Published on: June 16, 2014
Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease: Findings from the Salford
Rajkumar Chinnadurai1, Henry H L Wu2, Jones Abuomar3
1Donal O'Donoghue Renal Research Centre & Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom. rajkumar.chinnadurai@nca.nhs.uk.
Insights
Patients with chronic kidney disease (CKD) on three or more antihypertensive medications showed poorer outcomes. This highlights the need for optimized hypertension management in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Clinical Pharmacy
Background:
- Hypertension is a common comorbidity in chronic kidney disease (CKD) patients.
- The relationship between hypertension and CKD is complex and bidirectional, complicating treatment.
- Current antihypertensive treatment practices for CKD patients exhibit variability.
Purpose of the Study:
- To analyze antihypertensive prescribing patterns in CKD patients using the Salford Kidney Study database.
- To investigate the association between the number of antihypertensive agents prescribed and clinical outcomes in CKD.
Main Methods:
- Analysis of prospective data from the Salford Kidney Study (recruiting since 2002).
- Evaluation of antihypertensive prescription patterns relative to eGFR, urine albumin-creatinine ratio, CKD aetiology, and cardiovascular disease.
- Cox regression and Kaplan-Meier analyses were used to assess associations with mortality and survival.
Main Results:
- In 3,230 CKD patients, 53% with eGFR ≤ 15 mL/min/1.73 m² received ≥3 antihypertensives vs. 26% with eGFR ≥ 60 mL/min/1.73 m² (P < 0.001).
- Prescription of ≥3 agents increased with higher urine albumin-creatinine ratio categories (62% in A3 vs. 40% in A1, P < 0.001), notably for renin-angiotensin system blockers.
- Using ≥3 antihypertensives was linked to all-cause mortality (HR 1.15; 95% CI: 1.04-1.27, P = 0.006), irrespective of blood pressure control.
Conclusions:
- Antihypertensive prescribing in the Salford Kidney Study aligns with UK guidelines but shows poorer outcomes with multiple agents and uncontrolled blood pressure.
- Further research is needed to address variations in hypertension management for CKD patients globally.
Background:
Hypertension is commonly observed in patients living with chronic kidney disease (CKD). Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD. There remains variability in antihypertensive treatment practices.
Aim:
To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.
Methods:
The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002. All patients are followed up annually, and their medical records including the list of medications are updated until they reach study endpoints [starting on renal replacement therapy or reaching estimated glomerular filtration rate (eGFR) expressed as mL/min/1.73 m2 ≤ 10 mL/min/1.73 m2, or the last follow-up date, or data lock on December 31, 2021, or death]. Data on antihypertensive prescription practices in correspondence to baseline eGFR, urine albumin-creatinine ratio, primary CKD aetiology, and cardiovascular disease were evaluated. Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis. Kaplan-Meier analysis demonstrated differences in survival probabilities.
Results:
Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included. The median age was 65 years. A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages (53% of eGFR ≤ 15 mL/min/1.73 m2 vs 26% of eGFR ≥ 60 mL/min/1.73 m2, P < 0.001). An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased (category A3: 62% vs category A1: 40%, P < 0.001), with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers. The prescription of three or more antihypertensive agents was associated with all-cause mortality, independent of blood pressure control (hazard ratio: 1.15; 95% confidence interval: 1.04-1.27, P = 0.006). Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed (log-rank, P < 0.001).
Conclusion:
Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm. Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents. Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.
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