BP in Young Adults with CKD and Associations with Cardiovascular Events and Decline in Kidney Function

Abstract

BackgroundBP is an important modifiable risk factor for cardiovascular events and CKD progression in middle-aged or older adults with CKD. However, studies describing the relationship between BP with outcomes in young adults with CKD are limited.MethodsIn an observational study, we focused on 317 young adults (aged 21–40 years) with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Exposures included baseline systolic BP evaluated continuously (per 10 mm Hg increase) and in categories (<120, 120–129, and ≥130 mm Hg). Primary outcomes included cardiovascular events (heart failure, myocardial infarction, stroke, or all-cause death) and CKD progression (50% decline of eGFR or ESKD). We used Cox proportional hazard models to test associations between baseline systolic BP with cardiovascular events and CKD progression.ResultsCardiovascular events occurred in 52 participants and 161 had CKD progression during median follow-up times of 11.3 years and 4.1 years, respectively. Among those with baseline systolic BP ≥130 mm Hg, 3%/yr developed heart failure, 20%/yr had CKD progression, and 2%/yr died. In fully adjusted models, baseline systolic BP ≥130 mm Hg (versus systolic BP<120 mm Hg) was significantly associated with cardiovascular events or death (hazard ratio [HR], 2.13; 95% confidence interval [95% CI], 1.05 to 4.32) and CKD progression (HR, 1.68; 95% CI, 1.10 to 2.58).ConclusionsAmong young adults with CKD, higher systolic BP is significantly associated with a greater risk of cardiovascular events and CKD progression. Trials of BP management are needed to test targets and treatment strategies specifically in young adults with CKD.

Discordances between pediatric and adult thresholds in the diagnosis of hypertension in adolescents with CKD

“…One study of younger adults aged 20-40 years in South Korea did find a higher risk of cardiovascular disease outcomes, including myocardial infarction, stroke, and heart failure, among patients with moderate elevations in BP (SBP 120-129, DBP < 80 mmHg) and in those with hypertension [29]. This finding was contradicted by a [30]. Thus, the applicability of these findings in adolescents remains uncertain.…”

Systolic Blood Pressure and the Risk of Kidney Replacement Therapy and Mortality in Patients with Chronic Kidney Disease Stages 4–5

“…In the CRIC cohort, 319 young patients (20–40 years old) with CKD stage 3a were observed over an 11-year follow-up, and those with SBP >130 mm Hg had a 2.3-fold increased risk of CV events or death and a 68% increased risk of CKD progression [ 32 ]. The SPRINT study was terminated prematurely due to the evident positive results since those assigned to the strict BP group (<120/80 mm Hg) had 19% fewer CV events and an 18% reduction in all causes of death [ 24 ].…”

High Triglyceride-Glucose Index with Renal Hyperfiltration and Albuminuria in Young Adults: The Korea National Health and Nutrition Examination Survey (KNHANES V, VI, and VIII)

“…Chronic kidney disease (CKD) is associated with high rates of morbidity and mortality, resulting in a substantial socioeconomic burden [ 1 ]. Young adults with CKD are also at increased risk of adverse cardiovascular (CV) complications and mortality, similar to older CKD adults [ 2 , 3 ]. Despite advances in care for CKD, young adults with CKD still suffer from poor outcomes [ 4 ].…”