Blood Pressure and Chronic Kidney Disease Progression: An Updated Review

Abstract

Hypertension (HTN) is common in chronic kidney disease (CKD), and it may aggravate CKD progression. The optimal blood pressure (BP) value in CKD patients is not established yet, although systolic BP ≤130 mmHg is acceptable as a target. Continuous BP monitoring is essential to detect the different variants of high BP and monitor the treatment response. Various methods of BP measurement in the clinic office and at home are currently used. One of these methods is ambulatory BP monitoring (ABPM), by which BP can be closely assessed for even diurnal changes.We conducted a non-systematic literature review to explore and update the association between high BP and the course of CKD and to review various BP monitoring methods to determine the optimal method for BP recording in CKD patients. PubMed, EMBASE, Google, Google Scholar, and Web Science were searched for published reviews and original articles on BP and CKD by using various phrases and keywords such as "hypertension and CKD", "CKD progression and hypertension", "CKD stage and hypertension", "BP control in CKD", "BP measurement methods", "diurnal BP variation effect on CKD progression", and "types of hypertension." We evaluated and discussed published articles relevant to the review objective. Before preparing the final draft of this article, each author was assigned a section of the topic to read, research deeply, and write a summary about the assigned section. Then a summary of each author's contribution was collected and discussed in several group sessions.Early detection of high BP is essential to prevent CKD development and progression. Although the latest Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest that a systolic BP ≤120 mmHg is the target to prevent CKD progression, systolic BP ≤130 mmHg is universally recommended. ABPM is a promising method to diagnose and follow up on BP control; however, the high cost of the new devices and patient unfamiliarity with them have proven to be major disadvantages with regard to this method.

Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019, an ecological analysis of the global burden of diseases 2019 study

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Progression of chronic kidney disease among adults attending tertiary hospitals in Dodoma, Tanzania

“…Of the patients who had CKD progression, 72.2% had hypertension and there was a signi cant association of hypertension and CKD progression on univariate logistic regression analysis but this association was lost on multivariate logistic regression analysis. Studies have reported hypertension is an important risk factor for CKD development and CKD progression (51,52). The difference in study ndings could be due to similar prevalence rates of hypertension in both groups.…”

Sodium-Glucose Cotransporter 2 Inhibitors' Mechanism of Action and Use in Kidney Transplantation Recipients: Extended Review and Update

“…Higher glucose load to the last PCT segment leads to increased oxygen consumption and energy expenditure in the outer medulla [66][67][68] and local hypoxia, which can increase kidney damage. 69 Hypoxia triggers the activation of hypoxia-inducible factors HIF1 and HIF2, 70 increasing erythropoietin secretion 71 and improving the hemoglobin level. Additionally, the moderate reduction in volume leads to a rise in hemoglobin concentration, which promotes the efficient transport of oxygen to various organs, preventing hypoxia.…”