Hypertension Pharmacogenomics in CKD: The Clinical Relevance and Public Health Implications

Geng, Tingting; Jafar, Tazeen H.

doi:10.34067/kid.0007792021

Cited by 3 publications

(1 citation statement)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence of hypertension among patients with CKD is high and it is strongly associated with advanced CKD and CKD progression [ 30 , 31 ], the majority (96.7%) of patients with advanced CKD had hypertension, similar to findings in other studies from SSA [ 9 , 32 ]. Peripherally acting α-blockers like doxazosin are commonly used in the management of hypertension in CKD, mainly due to their pharmacokinetic profile that is undisturbed by worsening kidney function and their role in blood sugar control [ 33 , 34 ], approximately 51.4% of patients with advanced CKD were using doxazosin for treatment of hypertension with a 1.9 times increased association with advanced CKD, as also has been reported in other studies [ 35 , 36 ]. Studies have shown that diabetes related CKD is the leading cause of end stage kidney disease among patients with T2DM patients worldwide [ 37 , 38 ], approximately 38.7% patients with advanced CKD had T2DM; T2DM had 1.8 increased risk for advanced CKD, similar to other studies conducted among black patients in South Africa and Ethiopia [ 32 , 39 ].…”

Section: Discussionmentioning

confidence: 80%

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

et al. 2022

View full text Add to dashboard Cite

Background The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races. Methods A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD. Results A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46–67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In patients with advanced CKD, the median age was 61 (IQR 51–69) years, eGFR 33 (30–39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20–24), haemoglobin 12.9 (IQR 11.5–14.0) g/dl and serum uric acid 0.43 (IQR 0.37–0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2–9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1–3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9–6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2–5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7–4.9, P = 0.001), hyperuricemia (OR 2.4, 95% CI 1.4–4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2–3.1, P = 0.005). Other associations with advanced CKD were loss of spouse (widow/widower) (OR 3.2, 95% CI 1.4–7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1–5.1, P = 0.028), hyperkalemia (OR 5.4, 95% CI 1.2–24.1, P = 0.029), use of allopurinol (OR 2.4, 95% CI 1.4–4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2–3.1, P = 0.006). Conclusion Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, requiring clinicians and dietitians to be proactive in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.

show abstract

Section: Discussionmentioning

confidence: 80%

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

et al. 2022

View full text Add to dashboard Cite

show abstract

Digitalization of hypertension management: a paradigm shift

Kaur,

Gulati,

Baldi

2024

Naunyn-Schmiedeberg's Arch Pharmacol

View full text Add to dashboard Cite

Feasibility of Precision Medicine in Hypertension Management—Scope and Technological Aspects

Nitzan

2022

JPM

View full text Add to dashboard Cite

Personalized management of diseases by considering relevant patient features enables optimal treatment, instead of management according to an average patient. Precision management of hypertension is important, because both susceptibility to complications and response to treatment vary between individuals. While the use of genomic and proteomic personal features for widespread precision hypertension management is not practical, other features, such as age, ethnicity, and cardiovascular diseases, have been utilized in guidelines for hypertension management. In precision medicine, more blood-pressure-related clinical and physiological characteristics in the patient’s profile can be utilized for the determination of the threshold of hypertension and optimal treatment. Several non-invasive and simple-to-use techniques for the measurement of hypertension-related physiological features are suggested for use in precision management of hypertension. In order to provide precise management of hypertension, accurate measurement of blood pressure is required, but the available non-invasive blood pressure measurement techniques, auscultatory sphygmomanometry and oscillometry, have inherent significant inaccuracy—either functional or technological—limiting the precision of personalized management of hypertension. A novel photoplethysmography-based technique for the measurement of systolic blood pressure that was recently found to be more accurate than the two available techniques can be utilized for more precise and personalized hypertension management.

show abstract

Hypertension Pharmacogenomics in CKD: The Clinical Relevance and Public Health Implications

Cited by 3 publications

References 28 publications

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Digitalization of hypertension management: a paradigm shift

Feasibility of Precision Medicine in Hypertension Management—Scope and Technological Aspects

Contact Info

Product

Resources

About