Chapter 2: Lifestyle and pharmacological treatments for lowering blood pressure in CKD ND patients

doi:10.1038/kisup.2012.52

Cited by 13 publications

(4 citation statements)

References 98 publications

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“…Based on these historical observations, guidelines issued by the Japanese Society of Nephrology still recommend restricting sports for pediatric kidney disease patients [31]. However, it was recently reported in a systematic review that weight loss intervention attained to decrease proteinuria and BP in obese CKD patients [32]. Lifestyle modification including an exercise program should be encouraged in the guideline released by Kidney disease improving global outcomes [33] although this guideline also mentioned that an exercise program for lower-weight CKD patients with suspected malnutrition or inflammation still might be controversial.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study

et al. 2015

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Section: Discussionmentioning

confidence: 99%

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study

et al. 2015

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“…At least 70% of patients in the CKD population and at least 88% of patients in the MRA population reported hypertension. Steroidal MRA use was at least threefold higher in patients with HF than in those without HF, suggesting that most prescribing of steroidal MRAs was in line with current guidelines recommending their use in patients with hypertension or heart failure (New York Heart Association [NYHA] Class 3–4 and left ventricular ejection fraction ≤35%) [15, 16, 19, 20]. However, given the relatively low proportions of patients in the CKD population that were subsequently prescribed steroidal MRAs (less than 6%), our results suggest that steroidal MRA use is rare in clinical practice and are in line with other reports showing that steroidal MRA use is low even in guideline-eligible patients [21, 22].…”

Section: Discussionmentioning

confidence: 76%

“…Interestingly, steroidal MRAs were also prescribed to a proportion of patients with stage 4 and 5 CKD, or ESRD, for which they are contra-indicated. [19, 20]…”

Section: Discussionmentioning

confidence: 99%

Patient characteristics and initiation of mineralocorticoid receptor antagonists in patients with chronic kidney disease in routine clinical practice in the US: a retrospective cohort study

Blankenburg

Fett²,

Eisenring³

et al. 2019

BMC Nephrol

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Background Steroidal mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure (HF) and resistant hypertension, both common comorbidities in patients with diabetes and chronic kidney disease (CKD). This study explored the clinical characteristics of, and steroidal MRA use in, patients with CKD with and without type 2 diabetes mellitus (T2D) and/or HF. Methods This retrospective cohort study used PharMetrics Plus US claims database data (October 2009–September 2014) to identify two patient populations aged ≥18 years with a first diagnosis of CKD or a first prescription for steroidal MRAs. Demographic characteristics, comorbidities, clinical events, medication use and healthcare costs were reported by population and stratified by diagnosis: CKD, CKD + T2D (DKD), CKD + HF and DKD + HF. The CKD population cohorts were further stratified by steroidal MRA treatment duration (no MRAs, < 6 and ≥ 6 months’ treatment). Results The CKD and MRA populations comprised 229,004 patients and 5899 patients, respectively. Median age and the proportion of men were similar in the CKD and MRA populations across disease cohorts. Disease burden increased across the cohorts as comorbidity and clinical event incidences increased. Hypertension was reported in 70–92% of patients, irrespective of disease cohort or population. In the CKD population, MRA use was low but increased with disease burden: CKD, 1.2%; DKD, 1.8%; CKD + HF, 6.5%; and DKD + HF, 6.6%. Moreover, MRA users presented with higher rates of comorbidities and medication use, and higher healthcare costs than MRA non-users. Longer MRA treatment duration was associated with reduced polypharmacy, lower event rates and lower healthcare costs. In the MRA population, patients almost exclusively received spironolactone (≥ 96%; median dose across all groups 25 mg; one-year persistence, ≤ 43%); up to 16% of patients had end-stage renal disease at baseline despite steroidal MRAs being contraindicated. Conclusions Steroidal MRA use was low across all cohorts, but increased with disease severity, driven particularly by HF. Steroidal MRAs were used in patients with advanced CKD, despite being contraindicated. The persistent morbidity and clinical event rates in CKD and DKD patients highlight the disease burden and the need for treatments that effectively target both cardio-vascular and kidney-related events. Electronic supplementary material The online version of this article (10.1186/s12882-019-1348-4) contains supplementary material, which is available to authorized users.

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“…These measures include individualising BP targets with the use of various BP lowering agents, achieving and maintaining a healthy weight (BMI: 20-25 kg/m 2 ), lowering salt intake to <2 g (<90 mmol of sodium) per day, undertaking exercise that is compatible with CV health and tolerance for at least 30 min five times per week and limiting intake of alcohol as options for BP control. 9 BP exhibits a high level of short-term (24-hour ambulatory recordings) and long-term (office visit-to-visit) variability and both are associated with adverse outcomes independent of mean 24-hour or office-to-office BP values. 11 12 A number of studies have reported on the association between BP variability and risk CV events, progression of kidney failure or death in patients with CKD.…”

Section: Hypertension In Ckdmentioning

confidence: 99%

Impact of home telemonitoring and management support on blood pressure control in non-dialysis CKD: a systematic review protocol

et al. 2021

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IntroductionHypertension is a common public health problem and a key modifiable risk factor for cardiovascular (CV) and chronic kidney disease (CKD). Home blood pressure (BP) telemonitoring (HBPT) and management is associated with improved BP control, accelerated delivery of care and decision-making strategies that can reduce adverse outcomes associated with hypertension. The aim of this paper is to describe the protocol for a systematic review to assess the impact of HBPT interventions used for improving BP control and reducing CV and kidney outcomes in non-dialysis CKD patients.MethodsWe developed this protocol using the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015. We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO and grey literature for studies conducted in non-dialysis CKD patients on interventions using HBPT and reporting outcomes related to BP control and other outcomes such as CV events and kidney disease progression. All studies meeting these criteria, in adults and published from inception until 2020 with no language barrier will be included.Ethics and disseminationEthical approval will not be required for this review as the data used will be extracted from already published studies with publicly accessible data. As this study will assess the impact of HBPT on BP control in non-dialysis CKD patients, evidence gathered through it will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations and a report. We will also disseminate our findings to appropriate government agencies.PROSPERO registration numberCRD42020190705).

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Chapter 2: Lifestyle and pharmacological treatments for lowering blood pressure in CKD ND patients

Cited by 13 publications

References 98 publications

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study

Patient characteristics and initiation of mineralocorticoid receptor antagonists in patients with chronic kidney disease in routine clinical practice in the US: a retrospective cohort study

Impact of home telemonitoring and management support on blood pressure control in non-dialysis CKD: a systematic review protocol

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