Higher plasma renin activity is associated with increased kidney damage risk in patients with hypertension and glucose metabolic disorders

Abstract

The impact of renin on kidney remain unclear among hypertensives with glucose metabolic disorders (GMD). We aimed to evaluate the association between plasma renin activity (PRA) and kidney damage in hypertensive patients with GMD. Overall, 2033 inpatients with hypertension and GMD free of chronic kidney disease (CKD) at baseline were included. CKD was defined using estimated glomerular filtration rate (eGFR) and urine protein. PRA was treated as continuous variable, and also dichotomized as high (≥0.65) or low (< 0.65) groups. The association of PRA with incident CKD was evaluated using multivariable Cox model controlling for antihypertensive medications and baseline aldosterone, and traditional parameters. Subgroup and interaction analyses were performed to evaluate heterogeneity. During a median follow‐up of 31 months, 291 participants developed CKD. The incidence was higher in high‐renin group than that in low‐renin group (54.6 vs 36.6/1000 person‐years). Significant association was observed between PRA and incident CKD, and the association was mainly driven by an increased risk for proteinuria. Each standard deviation increment in log‐transformed PRA was associated with 16.7% increased risk of proteinuria (hazard ratio = 1.167, P = .03); compared with low‐renin group, there was 78.4% increased risk for high‐renin group (hazard ratio = 1.784, P = .001). Nonlinear associations were observed between PRA and kidney damage. Higher PRA is associated with greater risk of incident kidney damage, especially for positive proteinuria, in patients with coexistence of hypertension and diabetes, independent of aldosterone. In this patient population with high risk for kidney damage, PRA may serve as an important predictor.

The non-linear relationship between triglyceride-glucose index and risk of chronic kidney disease in hypertensive patients with abnormal glucose metabolism: A cohort study

“…Participants were inpatients from Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region in this retrospective study. The study design have been reported elsewhere ( 17 , 18 ). In brief, a total of 2,946 participants aged ≥ 18 years who diagnosed with hypertension and abnormal glucose metabolism between January 2012 and May 2019, were identified.…”

“…Diagnostic criteria for hypertension and abnormal glucose metabolism [including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diagnosed DM] have been described in previous studies ( 17 , 18 ).…”

“…If a participant experienced the outcomes more than once during follow-up, only the first outcome was used for analysis. For those without CKD during follow-up, the data of the last follow-up was included in the analysis ( 17 , 18 ).…”

“…elsewhere (17,18). In brief, a total of 2,946 participants aged ≥ 18 years who diagnosed with hypertension and abnormal glucose metabolism between January 2012 and May 2019, were identified.…”

Etiological Diagnosis and Personalized Therapy for Hypertension: A Hypothesis of the REASOH Classification

“…However, PRA is susceptible to the pharmacological effects of anti-hypertensive drugs. For example, diuretics can increase PRA by reducing systemic volume, while beta-blockers (BB) reduce PRA by decreasing sympathetic tension [ 14 ]. In addition, when patients are taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs), the true PRA can be overestimated by approximately 10% of the measured value [ 15 ].…”