BP Control and Long-Term Risk of ESRD and Mortality

Ku, Elaine; Gassman, Jennifer; Appel, Lawrence J.; Smogorzewski, Miroslaw; Sarnak, Mark J.; Glidden, David V.; Bakris, George L.; Gutiérrez, Orlando M.; Hebert, Lee A.; Ix, Joachim H.; Lea, Janice P.; Lipkowitz, Michael S.; Norris, Keith C.; Ploth, David W.; Pogue, Velvie A.; Rostand, Stephen G.; Siew, Edward D.; Sika, Mohammed; Tisher, C. Craig; Toto, Robert D.; Wright, Jackson T.; Wyatt, Christina M.; Hsu, Chi‐yuan

doi:10.1681/asn.2016030326

Cited by 73 publications

(57 citation statements)

References 44 publications

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“…29 Regarding the SBP-mortality association in later stages of CKD, a few observational studies have offered seemingly conflicting evidence, some suggesting a J-shaped association, 11,12 while one other showing no association between SBP and mortality. 30 More recently, using extended follow-up data from the MDRD (Modification of Diet in Renal Disease) Study and the African American Study of Kidney Disease and Hypertension trial, Ku et al 31,32 have shown an association of strict BP control (mean arterial pressure of ≤92 [versus 102–107] mmHg) with lower mortality risk in patients with moderate to advanced NDD-CKD. These studies, however, enrolled relatively small numbers of individuals with advanced NDD-CKD, including patients who did—as well as those who did not—reach ESRD.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality

Sumida

Molnár

Potukuchi

et al. 2017

American Journal of Kidney Diseases

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Background Mortality is extremely high immediately after transition to dialysis, but the association of blood pressure (BP) before dialysis initiation with mortality after dialysis initiation remains unknown. Study Design Observational study. Setting & Participants 17,729 US veterans transitioning to dialysis October 2007–September 2011, with a median follow-up of 2.0 years. Predictor Systolic BP (SBP) and diastolic BP (DBP) averaged over the last one-year pre-dialysis transition period as six (<120 to ≥160 mmHg in 10–mm Hg increments) and five (<60 to ≥90 mmHg in 10–mm Hg increments) categories, respectively, and as continuous measures. Outcomes & Measurements Post-dialysis all-cause mortality, assessed over different follow-up periods (i.e., <3, 3–<6, 6–<12, and ≥12 months after dialysis initiation) using Cox regressions adjusted for demographics, comorbidities, medications, cardiovascular medication adherence, body mass index, estimated glomerular filtration rate, and type of vascular access. Results The mean pre-dialysis SBPs and DBPs were 141.2±16.1 (SD) and 73.7±10.6 mm Hg, respectively. There was a reverse J-shaped association of SBP with all-cause mortality, with significantly higher mortality seen in SBP <140 mmHg. The mortality risks associated with lower SBP were greatest in the first 3 months after dialysis initiation, with multivariable-adjusted HRs of 2.40 (95% CI, 1.96–2.93), 1.99 (95% CI, 1.66–2.40), 1.35 (95% CI, 1.13–1.62), 0.98 (95% CI, 0.78–1.22), and 0.76 (95% CI, 0.57–1.00) for SBP <120, 120–<130, 130–<140, 150–<160, and ≥160 (versus 140–<150) mmHg, respectively. No consistent association was observed between pre-dialysis DBP and post-dialysis mortality. Limitations Results cannot infer causality and may not be generalizable to women or the general US population. Conclusions Lower pre-dialysis SBP is associated with higher all-cause mortality in the immediate post-dialysis period. Pre-dialysis DBP showed no consistent association with post-dialysis mortality. Further studies are needed to clarify ideal pre-dialysis SBP levels among incident dialysis patients as a potential means to improve the excessively high early dialysis mortality.

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Section: Discussionmentioning

confidence: 99%

Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality

Sumida

Molnár

Potukuchi

et al. 2017

American Journal of Kidney Diseases

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“…91,92 Monitoring for HTN in children with CKD Appropriate BP management is critical for reducing the risk of mortality in CKD. 95 Diagnosis and monitoring of HTN depends on accurate BP measurements; however, this is complicated in patients with CKD due to disease-induced alterations in diurnal BP rhythms. 5,96 There are three commonly used ways of monitoring BP: casual BP measurement, self-measured BP, and ABPM.…”

mentioning

confidence: 99%

Hypertension in pediatric patients with chronic kidney disease: management challenges

Gallibois¹,

Jawa²,

Noone³

2017

IJNRD

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Abstract:In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem.

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“…Our findings of an association between BP goal assignment and mortality also contrasts with the lack of benefit of strict BP control on renal outcomes previously reported by Parsa and colleagues, 7 and suggest that mortality may be more sensitive than renal outcomes to BP interventions. 25 …”

Section: Discussionmentioning

confidence: 99%

Strict blood pressure control associates with decreased mortality risk by APOL1 genotype

Lipkowitz

Appel

et al. 2017

Kidney International

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Although APOL1 high-risk genotype partially accounts for the increased susceptibility of blacks to chronic kidney disease (CKD), whether APOL1 associates differentially with mortality risk remains controversial. Here we evaluate the association between APOL1 genotype and risk of death, and determine whether APOL1 status modifies the association between strict versus usual blood pressure control and mortality risk. We performed a retrospective analysis of the African American Study of Kidney Disease and Hypertension trial which randomized black participants with CKD to strict versus usual blood pressure control from 1995 to 2001. This included 682 participants with known APOL1 genotype (157 with high-risk genotype) previously assigned to either strict (mean arterial pressure [MAP] 92 mm Hg or less) versus usual blood pressure control (MAP 102-107 mm Hg) during the trial. During a median follow-up of 14.5 years, risk of death did not differ between individuals with high- versus low-risk APOL1 genotypes (unadjusted hazard ratio 1.00 [95% confidence interval 0.76-1.33]). However, a significant interaction was detected between APOL1 risk group and blood pressure control strategy. In the APOL1 high-risk group, risk of death was 42% lower comparing strict versus usual blood pressure control (0.58 [0.35-0.97]). In the APOL1 low-risk group, risk of death comparing strict versus usual blood pressure control was not significantly different (1.09 [0.84-1.43]). Thus, strict blood pressure control during CKD associates with a lower risk of death in blacks with the high-risk CKD APOL1 genotype. Knowledge of APOL1 status could inform selection of blood pressure treatment targets in black CKD patients.

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BP Control and Long-Term Risk of ESRD and Mortality

Cited by 73 publications

References 44 publications

Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality

Blood Pressure Before Initiation of Maintenance Dialysis and Subsequent Mortality

Hypertension in pediatric patients with chronic kidney disease: management challenges

Strict blood pressure control associates with decreased mortality risk by APOL1 genotype

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