The Impact of Initial and Subsequent Blood Pressure Control on Renal Outcome in Moderate to Severe Chronic Kidney Disease Patients

Sheng-Li Cho ； Ping-Min Chen ； Tai-Shuan Lai ； Ping-Yu Chen ； Fan-Chi Chang ； Yi-Ting Chen ； Wen-Chih Chiang ； Shuei-Liong Lin ； Yung-Ming Chen

《Acta Nephrologica》 34卷3期 (2020/09) Pp. 127-135

https://doi.org/10.6221/AN.202009_34(3).0004

摘要

BACKGROUND: Hypertension is common in chronic kidney disease (CKD) patients and has been shown to be associated with CKD progression. However, optimal blood pressure (BP) control in advanced stages of CKD has been controversial. This study aims to examine the impact of baseline and subsequent BP control on renal outcome in advanced CKD patients. METHODS: A single-center retrospective study was conducted, enrolling 1,245 patients (age, 18-80; CKD stages 3B-5). BP on enrollment and in the first year were collected. Good BP was defined as systolic BP ＜ 130 mmHg and diastolic BP ＜ 80 mmHg, and otherwise as high BP. The renal outcome was compared according to baseline BP. Subsequently, patients were stratified into four groups according to initial and subsequent BP control. Renal survival analysis between the four groups was performed. The multivariate Cox regression model was applied to demonstrate the effect of individual risk factors on the outcome. Subgroup analysis was performed according to the baseline urine protein-to-creatinine ratio. RESULTS: Baseline high BP was associated with renal replacement therapy (RRT) (hazard ratio [HR], 1.314; P = 0.031). Those with good baseline and subsequent BP (group 1) had the best renal survival, followed by those with high baseline BP and good subsequent BP control (group 2); good baseline BP but high subsequent BP (group 3) and high baseline and subsequent BP (group 4) showed worse renal outcome. Compared with poor subsequent BP control (groups 3 and 4), good subsequent BP control (groups 1 and 2) was associated with a reduced risk of RRT (HR, 0.513; P = 0.008). The protective effect of BP control on renal outcome was more prominent in the overt proteinuria subgroup (HR, 0.452; P = 0.006). CONCLUSION: High baseline BP was a risk factor for CKD progression. There was a significantly improved renal outcome in the subsequent good BP control group compared with the poor control group. Our study revealed advanced CKD, especially with over proteinuria, patients with good BP control had a better renal outcome. This study suggests BP should be controlled in patients with advanced CKD to protect the kidney.

關鍵字

blood pressure ； chronic kidney disease ； disease progression ； hypertension ； renal outcome