How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice

Polychronopoulou, Erietta; Wuerzner, Grégoire; Burnier, Michel

doi:10.2147/vhrm.s292522

Cited by 14 publications

(14 citation statements)

References 84 publications

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“…Stage 5 CKD patients mainly rely on dialysis while waiting for kidney transplant. Kidney transplant is an excellent treatment for chronic kidney disease patients of stage 5 [31]. In the present study, a higher incidence of stage 5 CKD is found.…”

Section: Discussionsupporting

confidence: 58%

A Study on Etiology, Clinical Features and Complications of Chronic Kidney Disease Patients

Ubaid¹,

Mobin²,

Manzoor³

et al. 2022

PJMHS

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Background and Aim: Chronic kidney disease (CKD) is a major health issue that encompasses a variety of pathophysiological processes mostly related to declining rate of glomerular filtration and abnormal kidney function. Globally, the incidence of chronic kidney disease is increasing due to hypertension, diabetes, and cardiovascular disease. The present study aimed to investigate the etiology, clinical features, and complications of chronic kidney disease patients. Methodology: This cross-sectional study was conducted on 136 chronic kidney disease patients admitted to the Department of Medicine of Mamji Hospital, Karachi Pakistan from January 2021 to December 2021. Prior to study conduction, ethical approval from the research and ethical committee of the institute was taken. Informed consent was obtained from each individual. Demographic details, para-clinical and clinical features, etiology, and therapeutic features were the different outcome variables. Clinical examinations with detailed history and laboratory investigations were assessed. For laboratory examinations, urine and blood samples from each participant were taken. Data analysis with detailed descriptive statistics was carried out in SPSS version 25. Results: Out of 136 CKD patients, there were 74 (54.4%) male and 62 (45.6%) females. The overall mean age was 38.6±4.8 years. Age-wise distribution of the participants was as: 23 (16.9%) 15-25 years, 38 (27.9%) 26-35 years, 34 (25%) 36-45 years, 26 (19.1%) 46-55 years, and 15 (11.1%) >55 years. The chronic kidney disease associated comorbidities were high blood pressure (HBP) 64 (47.1%), human immunodeficiency virus (HIV) 25 (18.4%), Diabetic sugar 21 (15.4%), heart disease 19 (14%), and sickle cell anemia 7 (5.1%). Lesion diagnosis was found in 61 (44.9%) patients. The most prevalent diagnosis was chronic glomerulonephritis (CGN), Glam nephropathy, and vascular nephropathies presented in 27 (19.9%), 18 (13.2%), and 16 (11.8%) respectively. Intermediate 69 (50.7%), Hypertensive nephropathy 20 (14.7%), HIV-related nephropathy 17 (12.5%), Diabetic nephropathy 15 (11%), Primary segmental and focal hyalinosis 11 (8.2%), and Autosomal dominant polycystic kidney disease 4 (2.9%) were the different etiology diagnosed in CKD patients. The chronic disease complications such as Anemia, hyperkalaemia, hyperuricemia, uremic encephalopathy, right femoral venous thrombosis, and acute pulmonary edema were seen in 107 (78.7%), 54 (39.7%), 13 (9.6%), 9 (6.6%), 2 (1.5%), and 8 (5.9%) respectively. Conclusion: The present study concluded that hypertension, cardiovascular disease, diabetes, and HIV are the different predominant risk factors for chronic kidney disease. Also, the most prevalent etiology of the CKD was chronic glomerulonephritis (CGN) followed by Diabetic nephropathy in CKD patients. Anemia was the prevalent complication followed by hyperkalemia and hyperuricemia. Swelling at lower limb and weakness were the common symptoms of chronic kidney disease. Keywords: Etiology, Clinical features, Complications, Chronic Kidney Disease.

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Section: Discussionsupporting

confidence: 58%

A Study on Etiology, Clinical Features and Complications of Chronic Kidney Disease Patients

Ubaid¹,

Mobin²,

Manzoor³

et al. 2022

PJMHS

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“…There were 42% with early CKD and 58% with advanced CKD; 93.6% had hypertension and 33.0% diabetes mellitus, and 32.3% had both hypertension and diabetes. The prevalence of hypertension among patients with CKD is high and it is strongly associated with advanced CKD and CKD progression [30,31], the majority (96.7%) of patients with advanced CKD had hypertension, similar to findings in other studies from SSA [9,32]. Peripherally acting α-blockers like doxazosin are commonly used in the management of hypertension in CKD, mainly due to their pharmacokinetic profile that is undisturbed by worsening kidney function and their role in blood sugar control [33,34], approximately 51.4% of patients with advanced CKD were using doxazosin for treatment of hypertension with a 1.9 times increased association with advanced CKD, as also has been reported in other studies [35,36].…”

Section: Discussionmentioning

confidence: 99%

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

et al. 2022

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Background The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races. Methods A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD. Results A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46–67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In patients with advanced CKD, the median age was 61 (IQR 51–69) years, eGFR 33 (30–39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20–24), haemoglobin 12.9 (IQR 11.5–14.0) g/dl and serum uric acid 0.43 (IQR 0.37–0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2–9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1–3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9–6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2–5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7–4.9, P = 0.001), hyperuricemia (OR 2.4, 95% CI 1.4–4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2–3.1, P = 0.005). Other associations with advanced CKD were loss of spouse (widow/widower) (OR 3.2, 95% CI 1.4–7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1–5.1, P = 0.028), hyperkalemia (OR 5.4, 95% CI 1.2–24.1, P = 0.029), use of allopurinol (OR 2.4, 95% CI 1.4–4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2–3.1, P = 0.006). Conclusion Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, requiring clinicians and dietitians to be proactive in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.

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“…In patients with untreated Hypertension, elevated blood pressure may be caused by renal insufficiency 33 . UREA abnormalities are also closely associated with kidney disease development 34 , 35 , suggesting that Hypertension is a cause or consequence of kidney disease 36 .…”

Section: Discussionmentioning

confidence: 99%

Establishment and evaluation of a risk-prediction model for hypertension in elderly patients with NAFLD from a health management perspective

Zhang

Luo

Pan

et al. 2022

Sci Rep

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Elderly patients with nonalcoholic fatty liver disease are at a higher risk of developing. This study established an effective, individualised, early Hypertension risk-prediction model and proposed health management advice for patients over 60 years of age with NAFLD. Questionnaire surveys, physical examinations, and biochemical tests were conducted in 11,136 participants. The prevalence of NAFLD among 11,136 participants was 52.1%. Risk factors were screened using the least absolute shrinkage and selection operator model and random forest model. A risk-prediction model was established using logistic regression analysis and a dynamic nomogram was drawn. The model was evaluated for discrimination, calibration, and clinical applicability using receiver operating characteristic curves, calibration curves, decision curve analysis, net reclassification index (NRI), and external validation. The results suggested that the model showed moderate predictive ability. The area under curve (AUC) of internal validation was 0.707 (95% CI: 0.688–0.727) and the AUC of external validation was 0.688 (95% CI: 0.672–0.705). The calibration plots showed good calibration, the risk threshold of the decision curve was 30–56%, and the NRI value was 0.109. This Hypertension risk factor model may be used in clinical practice to predict the Hypertension risk in NAFLD patients.

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How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice

Cited by 14 publications

References 84 publications

A Study on Etiology, Clinical Features and Complications of Chronic Kidney Disease Patients

A Study on Etiology, Clinical Features and Complications of Chronic Kidney Disease Patients

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Establishment and evaluation of a risk-prediction model for hypertension in elderly patients with NAFLD from a health management perspective

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