Hypertension and the development of New onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia

Abstract

BackgroundLittle is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.MethodsThis is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m2 (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD.ResultsThe incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR (OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007).ConclusionsThe progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population.

Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria

“…This could have affected our renal function results among hypertensive donors. Reassuringly, as in previous studies , we found no evidence of further decline in renal function after 1 year, no proteinuria or albuminuria, and no donors at risk for end‐stage renal disease.…”

“…Ageing and hypertension are reported to be associated with progressive decline in renal function in the general population . These factors are part of the extended eligibility criteria of live kidney donors indicating that they would even have an increased risk with just one kidney and no renal reserve left.…”

Long‐Term Visit‐to‐Visit Blood Pressure Variability and Renal Function Decline in Patients With Hypertension Over 15 Years

“…Glycemic control, hypoalbuminemia, and high mean blood pressure (BP) are several other risk factors for CKD in patients with diabetes mellitus (DM). Hypertensive patients who are older, with underlying DM, hyperuricemia, and lower baseline estimated glomerular filtration rate (eGFR) may be more likely to develop CKD …”

“…Hypertensive patients who are older, with underlying DM, hyperuricemia, and lower baseline estimated glomerular filtration rate (eGFR) may be more likely to develop CKD. 5 Visit-to-visit blood pressure variability (BPV) has been shown to be a determinant in contributing to cardiovascular morbidity and mortality. [6][7][8] Several studies have shown the relationship between visit-to-visit BPV and further decline of renal function in patients with established CKD.…”

Clinical and Biological Determinants of Kidney Outcomes in a Population-Based Cohort Study

“…Clinical (e.g., age, smoking, diabetes, body mass index), biological (e.g., uric acid, HDL-cholesterol, triglycerides, homocysteine, C reactive protein, cytokines), and socioeconomic (e.g., education) factors associated with incident CKD and/or change in eGFR have been reported in prospective studies [7,8,9,10,11,12,13,14,15,16,17]. In addition to these factors, baseline kidney function (defined by eGFR or proteinuria) is independently associated with incident CKD and/or change in eGFR [18,19,20,21,22,23,24].…”