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Systolic blood pressure and chronic kidney disease progression in patients with primary glomerular disease

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Abstract

Introduction

Many current guidelines on optimal target blood pressure (BP) for chronic kidney disease (CKD) patients are largely based on studies in diabetic and hypertensive patients. However, there have been few studies in patients with glomerular diseases.

Methods

We retrospectively studied the longitudinal association between BP and CKD progression in 1,066 biopsy-proven patients diagnosed with primary glomerular diseases, including IgA nephropathy, membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), between 2005 and 2017. The main predictor was time-updated systolic blood pressure (SBP) at every clinic visit. The primary outcome was a composite one including ≥ 50% decrease in estimated glomerular filtration rate (eGFR) from the baseline, and end-stage kidney disease (ESKD).

Results

During 5009 person-years of follow-up, the primary outcome occurred in 157 (14.7%) patients. In time-varying Cox model, the adjusted hazard ratios (HRs) (95% confidence interval (CI)) for the primary outcome were 1.48 (0.96–2.29), 2.07 (1.22–3.52), and 2.53 (1.13–5.65) for SBP of 120–129, 130–139, and ≥ 140 mmHg, respectively, compared with SBP < 120 mmHg. This association was particularly evident in patients with elevated proteinuria. However, there was no association between baseline SBP and adverse kidney outcomes. Finally, prediction models failed to show the improvement of predictive performance of SBP compared with that of remission status. Moreover, patients with remission and less controlled SBP had better kidney outcomes than those with non-remission and well-controlled SBP.

Conclusion

Among patients with glomerular disease, higher time-updated SBP was significantly associated with higher risk of CKD progression. However, the clinical significance of blood pressure was less powerful than remission status.

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Acknowledgements

This research was supported by the Research of Korea Centers for Disease Control and Prevention (2019ER690101).

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None.

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Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Hyung Woo Kim, Jung Tak Park, Young Su Joo, Shin Chan Kang, Jee Young Lee, Sangmi Lee, Tae-Hyun Yoo, Shin-Wook Kang & Seung Hyeok Han

  2. Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, South Korea

    Young Su Joo

  3. Department of Internal Medicine, National Health Insurance Corporation Medical Center, Ilsan Hospital, Goyang si, South Korea

    Tae Ik Chang & Ea Wha Kang

  4. Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea

    Dong-Ryeol Ryu

  5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Ho Jun Chin

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  1. Hyung Woo Kim
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Consortia

The Korean GlomeruloNEphritis Study (KoGNET) Group

Contributions

SHH and HWK contributed to the research idea and study design; S-WK, T-HY, SHH, HJC, D-RR, EWK, TIC, JTP, and HWK were involved in data acquisition; SHH and HWK were responsible for data analysis/interpretation; SHH, YSJ, SCK, JYL, SL, and HWK contributed to statistical analysis; JTP, TIC, EWK, T-HY, HJC, S-WK, and SHH were responsible for data analysis/interpretation supervision or mentorship. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Seung Hyeok Han.

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The study was performed in accordance with the Declaration of Helsinki principles, and the institutional review board of Yonsei University Health System approved this retrospective study.

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Kim, H.W., Park, J.T., Joo, Y.S. et al. Systolic blood pressure and chronic kidney disease progression in patients with primary glomerular disease. J Nephrol 34, 1057–1067 (2021). https://doi.org/10.1007/s40620-020-00930-x

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  • DOI: https://doi.org/10.1007/s40620-020-00930-x

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