How Relevant and Frequent Is the Presence of Mild Renal Insufficiency in Essential Hypertension?

Abstract

Recent analyses of the influence of renal function on the cardiovascular outcome in essential hypertensive patients have confirmed the relevance of the kidney in cardiovascular prognosis even in the initial stages of renal failure. The evaluation of renal function in clinical practice is based mainly on the finding of changes in serum creatinine, but the estimation of creatinine clearance or its determination after 24-hour urine collection is not usually performed. The objective of this study was to analyze the prevalence of mild chronic renal insufficiency (MCRI) through the determination of creatinine clearance in patients with essential hypertension to reinforce the need to consider using this parameter in daily clinical practice. We analyzed clinical and biochemical data from 2686 essential hypertension patients referred to our unit from 1979-1999. MCRI was defined as a serum creatinine > or =1.5 mg/dL in men and > or =1.4 mg/dL in women, or a creatinine clearance estimated by the Cockroft-Gault formula or by a 24-hour urine collection of <60 mL/min. A prevalence of MCRI was found in 7.6% according to serum creatinine levels. This prevalence increased to 22.3% and 21.5% respectively when the diagnostic criteria for MCRI was the estimation of 24-hour creatinine clearance in urine, or its estimation using the Cockroft-Gault formula. When classified by creatinine clearance values, patients with MCRI were characterized by older age, elevated systolic blood pressure, higher serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides, lower levels of high-density lipoprotein cholesterol, higher serum uric acid, fasting serum glucose, serum potassium, and higher levels of urinary albumin excretion. In summary, MCRI is more prevalent in essential hypertension than previously thought, particularly if the estimated creatinine clearance is used to define MCRI. The finding of an altered renal function is associated with a significant increase in cardiovascular risk. This fact reinforces the need to pay attention to any of the manifestations of renal damage observed in the usual clinical assessment of any hypertensive patient.

Filtração glomerular e fatores associados em hipertensos atendidos na atenção básica

“…Age ≥ 65 years presented a significant association with reduced GF in both groups at the non-adjusted analysis and so it remained after the adjustment. National 10,20 and international studies 4,19 also observed a statistical significance of reduced GF with age. These findings confirm the increase in AP and CKD with age.…”

“…However, these formulas, although recommended, still need validation in large samples, in individuals at very early stages of kidney dysfunction and in elderly individuals 35,36 . Microalbuminuria significantly increases with the reduced GF 4 . Therefore, its measurement constitutes an important element in the early diagnosis and follow-up of CKD 9,30 .…”

Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients

“…The Heart Outcomes Prevention Evaluation (HOPE) study showed a prevalence of CKD of 10.4% according to serum creatinine values Ͼ 1.4 mg/dl (21). We have recently described that 7.6% of patients referred to our hypertension unit have a decreased renal function according to serum creatinine levels, and one of every four patients has a decreased creatinine clearance (12). The prevalence of CKD in the community could be even higher according to the values of estimated creatinine clearance seen in the Third National Health and Nutrition Examination Survey (NHANES III) (7,22).…”

“…In 500 untreated hypertensive patients followed until death, Perera (20) described that proteinuria was present in 42% and chronic renal failure in 18%. Growing evidence indicates that renal prognosis is not so good in either hypertensive patients or the general population (4,(7)(8)(9)(10)(11)(12). The Heart Outcomes Prevention Evaluation (HOPE) study showed a prevalence of CKD of 10.4% according to serum creatinine values Ͼ 1.4 mg/dl (21).…”

Depression and Quality of Life in Relation to Decreased Glomerular Filtration Rate Among Adults with Hypertension in Rural Northeast China

“…It has been demonstrated that even minor degrees of renal dysfunction were associated with an enhanced cardiovascular (CV) risk [2,3]. Among hypertensive patients, CKD is much more prevalent [4,5,6] and is a risk factor for CV events and all-cause mortality [7,8,9]. Guidelines for the management of hypertension have recognized the relevance of albuminuria and decreased estimated glomerular filtration rate (eGFR) on CV prognosis in hypertensive patients [10,11].…”