Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5
Introduction: In patients with chronic kidney disease stages 4 and 5 (CKD stages 4–5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control (<120 mm Hg) are associated with kidney replacement therapy (KRT) and mortality....
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| Format: | Article |
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Karger Publishers
2023-08-01
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| Series: | Kidney & Blood Pressure Research |
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| Online Access: | https://beta.karger.com/Article/FullText/533438 |
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| author | Jonathan S. Chávez-Iñiguez Jose J. Zaragoza Jahir R. Camacho-Guerrero Vanessa Villavicencio-Cerón Rafael Valdez-Ortiz Ana E. Huerta-Orozco Gael Chávez-Alonso Ana E. Oliva-Martinez Bladimir Díaz-Villavicencio Clementina E. Calderón-García Jose D. González-Barajas Manuel Arizaga-Nápoles Frida M. De La Vega-Méndez Juan A. Gómez-Fregoso Francisco G. Rodríguez-García Guillermo Navarro-Blackaller Ramón Medina-González Luz Alcantar-Vallin Guillermo García-García |
| author_facet | Jonathan S. Chávez-Iñiguez Jose J. Zaragoza Jahir R. Camacho-Guerrero Vanessa Villavicencio-Cerón Rafael Valdez-Ortiz Ana E. Huerta-Orozco Gael Chávez-Alonso Ana E. Oliva-Martinez Bladimir Díaz-Villavicencio Clementina E. Calderón-García Jose D. González-Barajas Manuel Arizaga-Nápoles Frida M. De La Vega-Méndez Juan A. Gómez-Fregoso Francisco G. Rodríguez-García Guillermo Navarro-Blackaller Ramón Medina-González Luz Alcantar-Vallin Guillermo García-García |
| author_sort | Jonathan S. Chávez-Iñiguez |
| collection | DOAJ |
| description | Introduction: In patients with chronic kidney disease stages 4 and 5 (CKD stages 4–5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control (<120 mm Hg) are associated with kidney replacement therapy (KRT) and mortality. Methods: In this retrospective cohort study, hypertensive CKD stages 4–5 patients attending the Renal Health Clinic at the Hospital Civil de Guadalajara were enrolled. We divided them into those that achieved SBP <120 mm Hg (controlled group) and those who did not (>120 mm Hg), the uncontrolled group. Our primary objective was to analyze the association between the controlled group and KRT; the secondary objective was the mortality risk and if there were subgroups of patients that achieved more benefit. Data were analyzed using Stata software, version 15.1. Results: During 2017–2022, a total of 275 hypertensive CKD stages 4–5 patients met the inclusion criteria for the analysis: 62 in the controlled group and 213 in the uncontrolled group; mean age 61 years; 49.82% were male; SBP was significantly lower in the controlled group (111 mm Hg) compared to the uncontrolled group (140 mm Hg); eGFR was similar between groups (20.41 mL/min/1.73 m2). There was a tendency to increase the mortality risk in the uncontrolled group (HR 6.47 [0.78–53.27]; p = 0.082) and an association by the Kaplan-Meir analysis (Log-rank p = 0.043). The subgroup analysis for risk of KRT in the controlled group revealed that patients ≥61 years had a lower risk of KRT (HR 0.87 [95% CI, 0–76-0.99]; p = 0.03, p of interaction = 0.005), but no differences were found in the subgroup analysis for mortality. In a follow-up of 1.34 years, no association was found in the risk of KRT according to the controlled or uncontrolled groups in a multivariate Cox analysis. Conclusion: In a retrospective cohort of patients with CKD stages 4–5 and hypertension, SBP >120 mm Hg was not associated with risk of KRT but could be associated with the risk of death. Clinical trials are required in this group of patients to demonstrate the impact of reaching the SBP goals recommended by the KDIGO guidelines. |
| first_indexed | 2024-03-12T11:50:16Z |
| format | Article |
| id | doaj.art-10613f1dfaaf40059e778e6bb77a5166 |
| institution | Directory Open Access Journal |
| issn | 1423-0143 |
| language | English |
| last_indexed | 2024-03-12T11:50:16Z |
| publishDate | 2023-08-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Kidney & Blood Pressure Research |
| spelling | doaj.art-10613f1dfaaf40059e778e6bb77a51662023-08-31T08:01:16ZengKarger PublishersKidney & Blood Pressure Research1423-01432023-08-011110.1159/000533438533438Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5Jonathan S. Chávez-Iñiguez0Jose J. Zaragoza1Jahir R. Camacho-Guerrero2Vanessa Villavicencio-Cerón3Rafael Valdez-Ortiz4Ana E. Huerta-Orozco5Gael Chávez-Alonso6Ana E. Oliva-Martinez7Bladimir Díaz-Villavicencio8Clementina E. Calderón-García9Jose D. González-Barajas10Manuel Arizaga-Nápoles11Frida M. De La Vega-Méndez12Juan A. Gómez-Fregoso13Francisco G. Rodríguez-García14Guillermo Navarro-Blackaller15Ramón Medina-González16Luz Alcantar-Vallin17Guillermo García-García18Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoMaster’s and Doctorate Program in Medical, Dental and Health Sciences, National Autonomous University of Mexico, Mexico City, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoIESS (Ecuadorian Institute of Social Security) General Hospital Portoviejo of the Ecuatorian Institute of Nephrology. Villa Renal (institute of Nephrology), Portoviejo, EcuadorService of Nephrology, General Hospital of Mexico, Dr. Eduardo Liceaga, Mexico City, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoUniversity of Guadalajara Health Sciences Center, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoNephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoUniversity of Guadalajara Health Sciences Center, Guadalajara, MexicoIntroduction: In patients with chronic kidney disease stages 4 and 5 (CKD stages 4–5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control (<120 mm Hg) are associated with kidney replacement therapy (KRT) and mortality. Methods: In this retrospective cohort study, hypertensive CKD stages 4–5 patients attending the Renal Health Clinic at the Hospital Civil de Guadalajara were enrolled. We divided them into those that achieved SBP <120 mm Hg (controlled group) and those who did not (>120 mm Hg), the uncontrolled group. Our primary objective was to analyze the association between the controlled group and KRT; the secondary objective was the mortality risk and if there were subgroups of patients that achieved more benefit. Data were analyzed using Stata software, version 15.1. Results: During 2017–2022, a total of 275 hypertensive CKD stages 4–5 patients met the inclusion criteria for the analysis: 62 in the controlled group and 213 in the uncontrolled group; mean age 61 years; 49.82% were male; SBP was significantly lower in the controlled group (111 mm Hg) compared to the uncontrolled group (140 mm Hg); eGFR was similar between groups (20.41 mL/min/1.73 m2). There was a tendency to increase the mortality risk in the uncontrolled group (HR 6.47 [0.78–53.27]; p = 0.082) and an association by the Kaplan-Meir analysis (Log-rank p = 0.043). The subgroup analysis for risk of KRT in the controlled group revealed that patients ≥61 years had a lower risk of KRT (HR 0.87 [95% CI, 0–76-0.99]; p = 0.03, p of interaction = 0.005), but no differences were found in the subgroup analysis for mortality. In a follow-up of 1.34 years, no association was found in the risk of KRT according to the controlled or uncontrolled groups in a multivariate Cox analysis. Conclusion: In a retrospective cohort of patients with CKD stages 4–5 and hypertension, SBP >120 mm Hg was not associated with risk of KRT but could be associated with the risk of death. Clinical trials are required in this group of patients to demonstrate the impact of reaching the SBP goals recommended by the KDIGO guidelines.https://beta.karger.com/Article/FullText/533438hypertensionkidney replacement therapychronic kidney diseasemortality |
| spellingShingle | Jonathan S. Chávez-Iñiguez Jose J. Zaragoza Jahir R. Camacho-Guerrero Vanessa Villavicencio-Cerón Rafael Valdez-Ortiz Ana E. Huerta-Orozco Gael Chávez-Alonso Ana E. Oliva-Martinez Bladimir Díaz-Villavicencio Clementina E. Calderón-García Jose D. González-Barajas Manuel Arizaga-Nápoles Frida M. De La Vega-Méndez Juan A. Gómez-Fregoso Francisco G. Rodríguez-García Guillermo Navarro-Blackaller Ramón Medina-González Luz Alcantar-Vallin Guillermo García-García Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5 Kidney & Blood Pressure Research hypertension kidney replacement therapy chronic kidney disease mortality |
| title | Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5 |
| title_full | Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5 |
| title_fullStr | Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5 |
| title_full_unstemmed | Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5 |
| title_short | Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5 |
| title_sort | systolic blood pressure and the risk of kidney replacement therapy and mortality in patients with chronic kidney disease stages 4 5 |
| topic | hypertension kidney replacement therapy chronic kidney disease mortality |
| url | https://beta.karger.com/Article/FullText/533438 |
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