Back to Search
Start Over
Acute Declines in Renal Function during Intensive BP Lowering: Implications for Future ESRD Risk.
- Source :
-
Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2017 Sep; Vol. 28 (9), pp. 2794-2801. Date of Electronic Publication: 2017 May 04. - Publication Year :
- 2017
-
Abstract
- The magnitude of decline in renal function that should be tolerated during intensive BP lowering and its association with risk of ESRD are unclear. To determine whether the acute declines in kidney function in the intensive BP lowering arm of two trials in CKD associated with higher risk of ESRD, we performed a retrospective study of 899 African American Study of Kidney Disease and Hypertension (AASK) and 761 Modification of Diet in Renal Disease (MDRD) Trial participants previously randomized to strict versus usual BP control. The predictor was the percentage decline in eGFR (<5%, 5% to <20%, or ≥20%) between randomization and months 3 and 4 of the trial (time to achieve BP goals). ESRD was the outcome of interest. Compared with a <5% eGFR decline in the usual BP arm, a 5% to <20% eGFR decline during intensive BP lowering did not associate with a higher risk of ESRD in the AASK (adjusted hazard ratio [aHR], 1.19; 95% confidence interval [95% CI], 0.84 to 1.68) or the MDRD Trial (aHR, 1.08; 95% CI, 0.84 to 1.40). However, a 5% to <20% eGFR decline in the usual BP arm associated with higher risk of ESRD in AASK (aHR, 1.83; 95% CI, 1.30 to 2.57) and MDRD Trial (aHR, 1.62; 95% CI, 1.25 to 2.11). A ≥20% eGFR decline associated with higher risk of ESRD in both strict and usual BP arms. Thus, acute eGFR declines ≥20% during intensive BP lowering identified a subset of patients at higher risk for adverse outcomes.<br /> (Copyright © 2017 by the American Society of Nephrology.)
- Subjects :
- Aged
Aged, 80 and over
Antihypertensive Agents administration & dosage
Female
Humans
Hypertension drug therapy
Male
Middle Aged
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic physiopathology
Retrospective Studies
Risk Factors
Antihypertensive Agents therapeutic use
Blood Pressure drug effects
Glomerular Filtration Rate drug effects
Kidney Failure, Chronic epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1533-3450
- Volume :
- 28
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of the American Society of Nephrology : JASN
- Publication Type :
- Academic Journal
- Accession number :
- 28473636
- Full Text :
- https://doi.org/10.1681/ASN.2017010040