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Blood pressure and chronic kidney disease progression in a multi-racial cohort: the Multi-Ethnic Study of Atherosclerosis

Journal of Human Hypertension volume 27, pages 421–426 (2013)Cite this article

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Abstract

The relationship between blood pressure (BP) and kidney function among individuals with chronic kidney disease (CKD) remains controversial. This study evaluated the association between BP and estimated glomerular filtration rate (eGFR) decline among adults with nondiabetic stage 3 CKD. The Multi-Ethnic Study of Atherosclerosis participants with an eGFR 30–59 ml min−1 per 1.73 m2 at baseline without diabetes were included. Participants were followed over a 5-year period. Kidney function change was determined by annualizing the change in eGFR using cystatin C, creatinine and a combined equation. Risk factors for progression of CKD (defined as a decrease in annualized eGFR>2.5 ml min−1 per 1.73 m2) were identified using univariate analyses and sequential logistic regression models. There were 220 participants with stage 3 CKD at baseline using cystatin C, 483 participants using creatinine and 381 participants using the combined equation. The median (interquartile range) age of the sample was 74 (68–79) years. The incidence of progression of CKD was 16.8% using cystatin C and 8.9% using creatinine (P=0.002). Systolic BP>140 mm Hg or diastolic BP>90 mm Hg was significantly associated with progression using a cystatin C-based (odds ratio (OR), 2.49; 95% confidence interval (CI), 1.12–5.52) or the combined equation (OR, 2.07; 95% CI, 1.16–3.69), but not when using creatinine after adjustment for covariates. In conclusion, with the inclusion of cystatin C in the eGFR assessment hypertension was an important predictor of CKD progression in a multi-ethnic cohort with stage 3 CKD.

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References

  1. Centers for Disease Control and Prevention (CDC). Hypertension-related mortality among hispanic subpopulations – United States, 1995–2002. MMWR 2006; 55 (7): 177–180.

    Google Scholar 

  2. Kramer H, Han C, Post W, Goff D, Diez-Roux A, Cooper R et al. Racial/ethnic differences in hypertension and hypertension treatment and control in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Hypertens 2004; 17 (10): 963–970.

    Article  Google Scholar 

  3. Kurth T, Jong PED, Cook NR, Buring JE, Ridker PM . Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study. BMJ 2009; 338 (1): b2392.

    Article  Google Scholar 

  4. Rao MV, Qiu Y, Wang C, Bakris G . Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES), 1999–2004. Am J Kidney Dis 2008; 51 (4 Suppl 2): S30–S37.

    Article  Google Scholar 

  5. Wright JT, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002; 288 (19): 2421–2431.

    Article  CAS  Google Scholar 

  6. Bianchi S, Bigazzi R, Campese VM . Intensive versus conventional therapy to slow the progression of idiopathic glomerular diseases. Am J Kidney Dis 2010; 55 (4): 671–681.

    Article  CAS  Google Scholar 

  7. Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE et al. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med 2003; 139 (4): 244–252.

    Article  CAS  Google Scholar 

  8. Sarnak MJ, Greene T, Wang X, Beck G, Kusek JW, Collins AJ et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med 2005; 142 (5): 342–351.

    Article  Google Scholar 

  9. Davis EM, Appel LJ, Wang X, Greene T, Astor BC, Rahman M et al. Limitations of analyses based on achieved blood pressure: lessons from the African American study of kidney disease and hypertension trial. Hypertension 2011; 57 (6): 1061–1068.

    Article  CAS  Google Scholar 

  10. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the Management of Arterial Hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25 (6): 1105–1187.

    Article  CAS  Google Scholar 

  11. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 (19): 2560–2572.

    Article  CAS  Google Scholar 

  12. Djamali A, Kendziorski C, Brazy PC, Becker BN . Disease progression and outcomes in chronic kidney disease and renal transplantation. Kidney Int 2003; 64 (5): 1800–1807.

    Article  Google Scholar 

  13. National Institutes of Health, National Institute of Diabetes and Kidney Disease. U.S. Renal Data System, USRDS 2009 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Kidney Disease: Bethesda, MD, 2009.

  14. Peralta CA, Katz R, Sarnak MJ, Ix J, Fried LF, De Boer I et al. Cystatin C identifies chronic kidney disease patients at higher risk for complications. J Am Soc Nephrol 2011; 22 (1): 147–155.

    Article  Google Scholar 

  15. Peralta CA, Katz R, DeBoer I, Ix J, Sarnak M, Kramer H et al. Racial and ethnic differences in kidney function decline among persons without chronic kidney disease. J Am Soc Nephrol 2011; 22 (7): 1327–1334.

    Article  Google Scholar 

  16. Bild DE, Bluemke DA, Burke GL, Detrano R, Diez Roux AV, Folsom AR et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol 2002; 156 (9): 871–881.

    Article  Google Scholar 

  17. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J of Kidney Dis 2002; 39 (2 Suppl 1): S1–S246.

    Google Scholar 

  18. Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008; 51 (3): 395–406.

    Article  CAS  Google Scholar 

  19. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130 (6): 461–470.

    Article  CAS  Google Scholar 

  20. Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 2012; 367 (1): 20–29.

    Article  CAS  Google Scholar 

  21. Kramer H, Palmas W, Kestenbaum B, Cushman M, Allison M, Astor B et al. Chronic kidney disease prevalence estimates among racial/ethnic groups: the Multi-Ethnic Study of Atherosclerosis. Clin J Am Soc Nephrol 2008; 3 (5): 1391–1397.

    Article  Google Scholar 

  22. Shlipak MG, Katz R, Kestenbaum B, Fried LF, Siscovick D, Sarnak MJ . Clinical and subclinical cardiovascular disease and kidney function decline in the elderly. Atherosclerosis 2009; 204 (1): 298–303.

    Article  CAS  Google Scholar 

  23. Rifkin DE, Shlipak MG, Katz R, Fried LF, Siscovick D, Chonchol M et al. Rapid kidney function decline and mortality risk in older adults. Arch Intern Med 2008; 168 (20): 2212–2218.

    Article  Google Scholar 

  24. Appel LJ, Wright JT, Greene T, Agodoa LY, Astor BC, Bakris GL et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med 2010; 363 (10): 918–929.

    Article  CAS  Google Scholar 

  25. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med 1994; 330 (13): 877–884.

    Article  CAS  Google Scholar 

  26. Ruggenenti P, Perna A, Loriga G, Ganeva M, Ene-Iordache B, Turturro M et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial. Lancet 2005; 365 (9463): 939–946.

    Article  Google Scholar 

  27. Groesbeck D, Köttgen A, Parekh R, Selvin E, Schwartz GJ, Coresh J et al. Age, gender, and race effects on cystatin C levels in US adolescents. Clin J Am Soc Nephrol 2008; 3 (6): 1777–1785.

    Article  CAS  Google Scholar 

  28. Peralta CA, Hicks LS, Chertow GM, Ayanian JZ, Vittinghoff E, Lin F et al. Control of hypertension in adults with chronic kidney disease in the United States. Hypertension 2005; 45 (6): 1119–1124.

    Article  CAS  Google Scholar 

  29. Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int 2009; 75 (6): 652–660.

    Article  CAS  Google Scholar 

  30. Coll E, Botey A, Alvarez L, Poch E, Quintó L, Saurina A et al. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000; 36 (1): 29–34.

    Article  CAS  Google Scholar 

  31. Roos JF, Doust J, Tett SE, Kirkpatrick CMJ . Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children--a meta-analysis. Clin Biochem 2007; 40 (5-6): 383–391.

    Article  CAS  Google Scholar 

  32. Bloch MJ, Basile J . African American patients with hypertensive chronic kidney disease receive no benefit on kidney disease progression from the currently recommended blood pressure goal of <130/80 mm Hg unless there is significant proteinuria at baseline: long-term follow-up of the AASK study. J Clin Hypertens 2011; 13 (3): 214–216.

    Article  Google Scholar 

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Acknowledgements

We thank the other investigators, the staff and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. This research was supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute, K01 TW008407-02 (to GSB) and R01 DK066488-01 (to MGS).

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Authors and Affiliations

  1. Division of Cardiology, School of Medicine, Duke University, Durham, NC, USA

    G S Bloomfield

  2. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    G S Bloomfield

  3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    S S Yi, B C Astor & W S Post

  4. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA

    B C Astor

  5. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    B C Astor

  6. Department of Preventive Medicine, Loyola Medical Center, Maywood, IL, USA

    H Kramer

  7. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    S Shea

  8. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    S Shea

  9. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    M G Shlipak

  10. General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

    M G Shlipak

  11. Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA

    W S Post

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Correspondence to W S Post.

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Bloomfield, G., Yi, S., Astor, B. et al. Blood pressure and chronic kidney disease progression in a multi-racial cohort: the Multi-Ethnic Study of Atherosclerosis. J Hum Hypertens 27, 421–426 (2013). https://doi.org/10.1038/jhh.2013.1

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  • DOI: https://doi.org/10.1038/jhh.2013.1

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