Proteinuria and blood pressure as causal components of progression to end-stage renal failure

Locatelli, Francesco; Marcelli, Daniele; Comelli, Mario; Alberti, Daniele; Graziani, G.; Buccianti, G.; Redaelli, B; Giangrande, A

doi:10.1093/ndt/11.3.461

Cited by 107 publications

(58 citation statements)

References 11 publications

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“…High BP is a known independent risk factor for faster decline of GFR (22)(23)(24). Consistent with these findings, we found that higher SBP (.157 mmHg) and DBP (.80 mmHg) were associated with progression to long-term dialysis.…”

Section: Discussionsupporting

confidence: 88%

Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

Palit¹,

Chonchol²,

Cheung³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objective The optimal BP target to reduce adverse clinical outcomes in patients with CKD is unclear. This study examined the relationship between BP and death, cardiovascular events (CVEs), and kidney disease progression in patients with advanced kidney disease.Design, setting, participants, & measurements The relationship of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) with death, CVE, and progression to long-term dialysis was examined in 1099 patients with advanced CKD (eGFR#30 ml/min per 1.7 3m 2 ; not receiving dialysis) who participated in the Homocysteine in Kidney and ESRD study. That study enrolled participants from 2001 to 2003. Cox proportional hazard models were used to examine the association between BP and adverse outcomes.Results The mean6SD baseline eGFR was 1867 ml/min per 1.73 m 2 . During a median follow-up of 2.9 years, 453 patients died, 215 had a CVE, and 615 initiated long-term dialysis. After adjustment for demographic characteristics and confounders, SBP, DBP, and PP were not associated with a higher risk of death. SBP and DBP were also not associated with CVE. The highest quartile of PP was associated with a substantial higher risk of CVE compared with the lowest quartile (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.10 to 2.52). The highest quartiles of SBP (HR, 1.28; 95% CI, 1.01 to 1.61) and DBP (HR, 1.36; 95% CI, 1.07 to 1.73), but not PP, were associated with a higher risk of progression to long-term dialysis compared with the lowest quartile.Conclusions In patients with advanced kidney disease not undergoing dialysis, higher PP was strongly associated with CVE whereas higher SBP and DBP were associated with progression to long-term dialysis. These results suggest that SBP and DBP should not be the only factors considered in determining antihypertensive therapy; elevated PP should also be considered.

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Section: Discussionsupporting

confidence: 88%

Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

Palit¹,

Chonchol²,

Cheung³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…In adults, HTN is an independent risk factor for CKD progression (159)(160)(161) and also in a large prospective study of children with CKD SBP greater than 120 mmHg has been associated with a faster decline of GFR (162).…”

Section: Chronic Kidney Disease and Renal Insufficiencymentioning

confidence: 94%

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Lurbe

Agabiti‐Rosei

Cruickshank

et al. 2016

Journal of Hypertension

1,089

1,063

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“…CKD is also related to a decrease in quality of life and cognitive function (2). Hypertension and proteinuria promote CKD progression and increase the risk of CVD and mortality (3). Blockade of the reninangiotensin-aldosterone system (RAAS) is well known to reduce urinary albumin excretion, and it is considered a mainstay of therapy in the prevention of ESRD (4,5).…”

Section: Introductionmentioning

confidence: 99%

Effects of Intensive Low-Salt Diet Education on Albuminuria among Nondiabetic Patients with Hypertension Treated with Olmesartan

Hwang

Chin

Kim

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The antiproteinuric effect of a renin-angiotensin-aldosterone system blockade can be magnified by dietary salt restriction. This study sought to determine the effect of intensive low-salt diet education on BP and urine albumin excretion in nondiabetic patients with hypertension and albuminuria. Conclusions The 24-hour urinary albumin excretion was decreased more in patients in the intensive low-salt diet education group than patients in the conventional education group. Weekly intensive education on a lowsalt diet would be a suitable method for clinical practice.

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Proteinuria and blood pressure as causal components of progression to end-stage renal failure

Abstract: Only primary renal disease and proteinuria were related to renal survival, being baseline plasma creatinine confounding factor. By blocking the possible causal role of proteinuria and hypertension, end-stage renal failure could be prevented in a significant percentage of patients.

Cited by 107 publications

References 11 publications

Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Effects of Intensive Low-Salt Diet Education on Albuminuria among Nondiabetic Patients with Hypertension Treated with Olmesartan

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