Influence of Multiple Risk Factor Management on the Onset and Progression of Chronic Kidney Disease in Patients With...

Patients with hypertension face a significantly elevated risk of renal dysfunction. However, whether this risk can be mitigated by joint risk factor control remains uncertain.

Using Cox proportional hazards models, this study investigated the association between the number of controlled baseline risk factors (systolic blood pressure, low-density lipoprotein cholesterol, fasting blood glucose, and body mass index) and the development and progression of chronic kidney disease.

We analyzed 77 356 participants with hypertension and 1:1 age- and sex-matched counterparts without hypertension for incident chronic kidney disease over a median follow-up of 13.40 years. Among participants with hypertension, each additional controlled risk factor was associated with an 18% lower risk of chronic kidney disease (hazard ratio [HR], 0.82 [95% CI, 0.81-0.84]), and controlling all 4 factors (versus ≤1) reduced the risk by 42% (HR, 0.58 [95% CI, 0.52-0.63]). Effective multifactorial management progressively narrowed the risk gap between hypertensive and normotensive individuals. Chronic kidney disease progression was assessed in 9543 participants with hypertension and 6799 participants without hypertension over 11.88 years. Each additional controlled risk factor was associated with an 18% lower progression risk (HR, 0.82 [95% CI, 0.78-0.86]). Controlling 3 factors was sufficient to eliminate the excess progression risk between groups with hypertension and groups without hypertension, while controlling all 4 factors lowered the risk by 31% (HR, 0.69 [95% CI, 0.53-0.89]).

This study demonstrates a clear dose-response relationship between the number of controlled risk factors and the magnitude of kidney risk reduction. A comprehensive, multifactorial control strategy can progressively reduce and potentially normalize the excess kidney risk in hypertensive individuals. These findings support a more quantitative and stage-specific approach to hypertension management.