The correlation between blood pressure and kidney function decline in older people: a registry-based cohort study

Abstract

ObjectivesTo examine the relation between static and dynamic blood pressure (BP) measurements and the evolution of kidney function in older people, adjusted for the presence of multimorbidity.DesignRetrospective cohort study during a 10-year time interval (2002–2012) in three age strata of patients aged 60 and older.SettingPrimary care registration network with 97 general practitioners working in 55 practices regularly submitting collected patient data.ParticipantsAll patients with at least one BP measurement in 2002 and at least four serum creatine measurements after 2002 (n=8636). A modified Charlson Comorbidity Index (mCCI) at baseline was registered. Change in systolic and diastolic BP (DBP) and pulse pressure (PP) from 2002 onwards was calculated. The relation between kidney function evolution and baseline BP and change in BP was examined using linear and logistic regression analysis.Main outcome measuresThe slope of the estimated glomerular filtration rate (eGFR, MDRD, Modification of Diet in Renal Disease equation) was calculated by the ordinal least square method. A rapid annual decline of kidney function was defined as ≥3 mL/min/1.73 m2/year.ResultsRapid annual decline of kidney function occurred in 1130 patients (13.1%). High baseline systolic BP (SBP) and PP predicted kidney function decline in participants aged 60–79 years. No correlation between baseline BP and kidney function decline was found in participants aged 80 years and older. An annual decline of ≥1 mm Hg in SBP and PP was a strong risk factor for a rapid annual kidney function decline in all age strata, independent of baseline BP and mCCI. A decline in DBP as also a strong independent predictor in participants aged 60–79 years.ConclusionsThe present study identified a decline in BP over time as a strong risk factor for kidney function decline in all age strata, adjusted for mCCI and baseline kidney function and BP.

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

“…Rate of renal function decline was estimated by fitting a linear regression line through the eGFR measurements for each individual patient and expressed as eGFR slope (mL/min per 1.73 m 2 per year). This method has been used in other studies as well because eGFR at a point of time may not truly be reflective of change in kidney function due to its variability . eGFR was categorized according to the KDIGO 2012 guideline (Table S1).…”

“…This method has been used in other studies as well because eGFR at a point of time may not truly be reflective of change in kidney function due to its variability. [13][14][15][16] eGFR was categorized according to the KDIGO 2012 guideline (Table S1). Onset of CKD is defined as eGFR <60 mL/min per 1.73 m 2 .…”

El medio interno del adulto mayor comparado con el del adulto joven de pacientes que acuden al servicio de emergencia de un hospital general de Lima-Perú, estudio de casos y controles

“…Como consecuencia de la técnica del muestreo accidental (muestreo no probabilístico), no se logró controlar todas las variables, lo que generó diferencias en las condiciones basales entre ambos grupos, por ejemplo, el grupo del adulto mayor estuvo cargado con pacientes hipertensos lo que pudo devenir en una variable de confusión, esta diferencia estaría traduciendo la mayor prevalencia de hipertensión arterial en el adulto mayor, llegando en algunas series a bordear el 80% [19] , mientras que en la población general la prevalencia de hipertensión arterial en Perú, estaría alrededor del 24% [20] , entonces, es posible que el muestreo accidental este reflejando dicha diferencia. En todo caso, esta situación que pudo haber favorecido una mayor frecuencia y/o gravedad de las alteraciones del medio interno [21,22] , no tendría sustento de acuerdo con los resultados de nuestro estudio.…”

Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009–2013: A Registry-Based Retrospective Cohort Study

“…The Flemish Intego network (for details see Truyers et al [ 21 ], Truyers et al [ 22 ], and Vaes et al [ 23 ]) is “the only operational computerized morbidity registration network in Belgium based on general practice data” [ 21 , p. 1]. Over 90 Intego GPs (see Table 1 ), who are good coders, collect data on about 2% “of the Flemish population representative in terms of age and sex” [ 21 , p. 1].…”

“…Over 90 Intego GPs (see Table 1 ), who are good coders, collect data on about 2% “of the Flemish population representative in terms of age and sex” [ 21 , p. 1]. “Intego procedures were approved by the ethical review board of the Medical School of the Catholic University of Leuven (N° ML 1723) and by the Belgian Privacy Commission (number SCSZG/13/079)” [ 23 , p. 10].…”