Association of blood pressure with decline in renal function and time until the start of renal replacement therapy in pre-dialysis patients: a cohort study

BMC Nephrology

Diana C Grootendorst³  Friedo W Dekker²  Yvo WJ Sijpkens¹  Elisabeth W Boeschoten⁴  Dinanda J de Jager²  Nynke Halbesma²  Nora Voormolen²  Moniek CM de Goeij² 

[1]Bronovo Hospital, Bronovolaan 5, 2597 AX the Hague, the Netherlands

[2]Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands

[3]Linnaeus Institute, Kennemer Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, the Netherlands

[4]Hans Mak Institute, Koningin Wilhelminalaan 29-B, 1411 EL Naarden, the Netherlands

关键词: renal replacement therapy;    pre-dialysis care;    estimated glomerular filtration rate;    chronic kidney disease stages IV-V;    blood pressure;   

Others  :  1083245
DOI  :  10.1186/1471-2369-12-38

 received in 2011-04-21, accepted in 2011-08-11,  发布年份 2011

【 摘 要 】

Background

To investigate whether high blood pressure accelerates renal function decline in patients with advanced chronic kidney disease (CKD), we studied the association of systolic (SBP) and diastolic blood pressure (DBP) with decline in renal function and time until the start of renal replacement therapy (RRT) in patients with CKD stages IV-V on pre-dialysis care.

Methods

In the PREPARE-1 cohort 547 incident pre-dialysis patients, referred as part of the usual care to outpatient clinics of eight Dutch hospitals, were included between 1999 and 2001 and followed until the start of RRT, mortality, or end of follow-up (January 1^st 2008). Main outcomes were rate of decline in renal function, estimated as the slope of available eGFR measurements, and time until the start of RRT.

Results

A total of 508 patients, 57% men and median (IQR) age of 63 (50-73) years, were available for analyses. Mean (SD) decline in renal function was 0.35 (0.75) ml/min/1.73 m²/month. Every 10 mmHg increase in SBP or DBP resulted in an accelerated decline in renal function (adjusted additional decline 0.04 (0.02;0.07) and 0.05 (0.00;0.11) ml/min/1.73 m²/month respectively) and an earlier start of RRT (adjusted HR 1.09 (1.04;1.14) and 1.16 (1.05;1.28) respectively). Furthermore, patients with SBP and DBP above the BP target goal of < 130/80 mmHg experienced a faster decline in renal function (adjusted additional decline 0.31 (0.08;0.53) ml/min/1.73 m²/month) and an earlier start of RRT (adjusted HR 2.08 (1.25;3.44)), compared to patients who achieved the target goal (11%). Comparing the decline in renal function and risk of starting RRT between patients with only SBP above the target (≥ 130 mmHg) and patients with both SBP and DBP below the target (< 130/80 mmHg), showed that the results were almost similar as compared to patients with both SBP and DBP above the target (adjusted additional decline 0.31 (0.04;0.58) ml/min/1.73 m²/month and adjusted HR 2.24 (1.26;3.97)). Therefore, it seems that especially having SBP above the target is harmful.

Conclusions

In pre-dialysis patients with CKD stages IV-V, having blood pressure (especially SBP) above the target goal for CKD patients (< 130/80 mmHg) was associated with a faster decline in renal function and a later start of RRT.

【 授权许可】

   
2011 de Goeij et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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