Blood pressure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Cheung, Alfred K.; Chang, Tara I.; Cushman, William C.; Furth, Susan L.; Ix, Joachim H.; Pécoits-Filho, Roberto; Perkovic, Vlado; Sarnak, Mark J.; Tobe, Sheldon W.; Tomson, Charles; Cheung, Michael; Wheeler, David C.; Winkelmayer, Wolfgang C.; Mann, Johannes F.E.; Bakris, George L.; Damasceno, Albertino; Dwyer, Jamie P.; Fried, Linda F.; Haynes, Richard; Hirawa, Nobuhito; Holdaas, Hallvard; Ibrahim, Hassan N.; Ingelfinger, Julie R.; Iseki, Kunitoshi; Khwaja, Arif; Kimmel, Paul L.; Kövesdy, Csaba P.; Ku, Elaine; Lerma, Edgar V.; Luft, Friedrich C.; Lv, Jicheng; McFadden, Christopher B.; Muntner, Paul; Myers, Martin G.; Navaneethan, Sankar D.; Parati, Gianfranco; Peixoto, Aldo J.; Prasad, Ramesh; Rahman, Mahboob; Rocco, Michael V.; Rodrigues, Cibele Isaac Saad; Roger, Simon D.; Stergiou, George S.; Tomlinson, Laurie; Tonelli, Marcello; Toto, Robert D.; Tsukamoto, Yusuke; Walker, Robert G.; Wang, Angela Yee-Moon; Wang, Ji‐Guang; Warady, Bradley A.; Whelton, Paul K.; Williamson, Jeff D.

doi:10.1016/j.kint.2018.12.025

Cited by 62 publications

(54 citation statements)

References 110 publications

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“…We did find higher SBP was associated with rapid progression in the univariate analysis (Additional file 1: Table S3), but it was not significant after adjustment of other covariates. Further work may be required to better understand the clinical implications of DBP in those with advanced CKD, an issue recently identified by the renal community warranting further review [28].…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

et al. 2020

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Background: Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear estimated glomerular filtration rate (eGFR) trajectory represent a clear paradigm for understanding true CKD progression. Methods: A linear regression slope was applied to all outpatient eGFR values for patients in the Salford Kidney Study who had ≥2 years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤ − 4 ml/min/1.73m 2 /yr defined rapid progressors, whereas − 0.5 to + 0.5 ml/min/1.73m 2 /yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD. Results: There were 157 rapid progressors (median ΔeGFR − 5.93 ml/min/1.73m 2 /yr) and 179 stable patients (median ΔeGFR − 0.03 ml/min/1.73m 2 /yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of > 50 g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure. Conclusions: There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

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Section: Discussionmentioning

confidence: 99%

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

et al. 2020

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show abstract

“…We did nd higher SBP was associated with rapid progression in the univariate analysis (Additional le 1: Table S3), but it was not signi cant after adjustment of other covariates. Further work may be required to better understand the clinical implications of DBP in those with advanced CKD, an issue recently identi ed by the renal community warranting further review [28].…”

Section: Predictive Factors Associated With Progressionmentioning

confidence: 99%

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Ali

Chinnadurai

Ibrahim

et al. 2020

Preprint

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Abstract Background Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear eGFR trajectory represent a clear paradigm for understanding true CKD progression. Methods A linear regression slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for patients in the Salford Kidney Study who had ≥2years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤-4ml/min/1.73m2/yr defined rapid progressors, whereas -0.5 to +0.5ml/min/1.73m2/yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD. Results There were 157 rapid progressors (median ΔeGFR -5.93ml/min/1.73m2/yr) and 179 stable patients (median ΔeGFR -0.03ml/min/1.73m2/yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of >50g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure. Conclusions There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

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“…52,53 In addition to their effects on blood pressure, renin-angiotensin system blockers increase nephrin levels in the podocytes and reduce plasminogen acivator inhibitor-1 expression, suggesting that these drugs are a reasonable first choice for the treatment of anti-VEGF−induced hypertension and proteinuria, 52,53 and are consistent with Kidney Disease Outcomes Quality Initiative and Kidney Disease Improving Global Outcomes guidelines. 54,55 However, randomized controlled clinical trials still will be needed to validate these recommendations. In patients with persistent severe proteinuria, especially if in the nephrotic range, interruption or permanent discontinuation of therapy should be considered.…”

Section: Management Of Hypertension Induced By Antiangiogenic Therapymentioning

confidence: 99%

Renal Toxicity of Systemic Therapy for Renal Cell Carcinoma

Jaimes

2020

Seminars in Nephrology

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Blood pressure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Cited by 62 publications

References 110 publications

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Renal Toxicity of Systemic Therapy for Renal Cell Carcinoma

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