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Annual deterioration of renal function in hypertensive patients with and without diabetes.
Vasc Health Risk Manag. 2017; 13:231-237.VH

Abstract

BACKGROUND

Chronic kidney disease (CKD) complicates hypertension and diabetes. Knowledge of the deterioration rate of CKD may anticipate adjustment of therapies with renal elimination. This study evaluates the rate of annual deterioration of renal function in hypertensive patients either with type 2 diabetes (DM2) or without it (non-DM) followed for 5 years and relates it with blood pressure (BP) and glycemic control.

MATERIALS AND METHODS

Out of a total of 1924 patients, 1023 patients (594 non-DM and 429 DM2, 53% female, aged 62.1±10.2 years) were evaluated over 5 years for the annual evolution of renal function (estimated glomerular filtration rate [eGFR], Modification of Diet in Renal Disease) ambulatory 24-hour blood pressure and metabolic parameters, corresponding to the analysis of 2378 patient-years.

RESULTS

DM2 and non-DM did not differ for age, mean 24-hour BP levels, nighttime BP, albuminuria, and body mass index. DM2 versus non-DM showed a higher (p<0.02) prevalence of stage 3 CKD (24.0% vs 18.0%, eGFR 30-59), stage 4 (5.4% vs 2.7%, eGFR 15-29), and stage 5 (0.8% vs 0.5%, eGFR <15). Average annual decline of eGFR was 3.3±8.2 in DM2 versus 2.4±7.7 in non-DM (p=0.12, nonsignificant). Annual changes of eGFR and of albuminuria correlated (r=0.578, p<0.001). In multivariate analysis, age, nighttime BP, double inhibition of renin angiotensin system, albuminuria, and HbA1c >8.0% in DM2 predicted the decline in eGFR. On average, 16.2% of DM2 and 13.1% of non-DM moved each year toward a more severe stage of CKD. For initial eGFR <90 mL/min/1.73 m2, 26.4% of DM2 and 18.1% of non-DM patients showed a reduction per year >10% from the previous eGFR value (p=0.042).

CONCLUSION

Progressive deterioration of renal function each year is frequent in hypertensive diabetic and non-diabetic patients. Beyond aging, this is particularly dependent on BP control particularly at nighttime, on drug therapy, and on highly abnormal glucose control.

Authors+Show Affiliations

Department of Medicine, CINTESIS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal. Blood Pressure Unit, Hospital Pedro Hispano, Matosinhos, Portugal.Department of Medicine, CINTESIS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal.Department of Medicine, CINTESIS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal.Blood Pressure Unit, Hospital Pedro Hispano, Matosinhos, Portugal.Department of Medicine, CINTESIS, Faculty of Medicine of Porto, University of Porto, Porto, Portugal. Blood Pressure Unit, Hospital Pedro Hispano, Matosinhos, Portugal.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28721063

Citation

Polonia, Jorge, et al. "Annual Deterioration of Renal Function in Hypertensive Patients With and Without Diabetes." Vascular Health and Risk Management, vol. 13, 2017, pp. 231-237.
Polonia J, Azevedo A, Monte M, et al. Annual deterioration of renal function in hypertensive patients with and without diabetes. Vasc Health Risk Manag. 2017;13:231-237.
Polonia, J., Azevedo, A., Monte, M., Silva, J. A., & Bertoquini, S. (2017). Annual deterioration of renal function in hypertensive patients with and without diabetes. Vascular Health and Risk Management, 13, 231-237. https://doi.org/10.2147/VHRM.S135253
Polonia J, et al. Annual Deterioration of Renal Function in Hypertensive Patients With and Without Diabetes. Vasc Health Risk Manag. 2017;13:231-237. PubMed PMID: 28721063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Annual deterioration of renal function in hypertensive patients with and without diabetes. AU - Polonia,Jorge, AU - Azevedo,André, AU - Monte,Miguel, AU - Silva,José A, AU - Bertoquini,Susana, Y1 - 2017/06/26/ PY - 2017/7/20/entrez PY - 2017/7/20/pubmed PY - 2017/9/19/medline KW - adults KW - annual deterioration KW - caucasians KW - chronic kidney disease KW - diabetes KW - diabetes type 2 KW - hypertension KW - renal function SP - 231 EP - 237 JF - Vascular health and risk management JO - Vasc Health Risk Manag VL - 13 N2 - BACKGROUND: Chronic kidney disease (CKD) complicates hypertension and diabetes. Knowledge of the deterioration rate of CKD may anticipate adjustment of therapies with renal elimination. This study evaluates the rate of annual deterioration of renal function in hypertensive patients either with type 2 diabetes (DM2) or without it (non-DM) followed for 5 years and relates it with blood pressure (BP) and glycemic control. MATERIALS AND METHODS: Out of a total of 1924 patients, 1023 patients (594 non-DM and 429 DM2, 53% female, aged 62.1±10.2 years) were evaluated over 5 years for the annual evolution of renal function (estimated glomerular filtration rate [eGFR], Modification of Diet in Renal Disease) ambulatory 24-hour blood pressure and metabolic parameters, corresponding to the analysis of 2378 patient-years. RESULTS: DM2 and non-DM did not differ for age, mean 24-hour BP levels, nighttime BP, albuminuria, and body mass index. DM2 versus non-DM showed a higher (p<0.02) prevalence of stage 3 CKD (24.0% vs 18.0%, eGFR 30-59), stage 4 (5.4% vs 2.7%, eGFR 15-29), and stage 5 (0.8% vs 0.5%, eGFR <15). Average annual decline of eGFR was 3.3±8.2 in DM2 versus 2.4±7.7 in non-DM (p=0.12, nonsignificant). Annual changes of eGFR and of albuminuria correlated (r=0.578, p<0.001). In multivariate analysis, age, nighttime BP, double inhibition of renin angiotensin system, albuminuria, and HbA1c >8.0% in DM2 predicted the decline in eGFR. On average, 16.2% of DM2 and 13.1% of non-DM moved each year toward a more severe stage of CKD. For initial eGFR <90 mL/min/1.73 m2, 26.4% of DM2 and 18.1% of non-DM patients showed a reduction per year >10% from the previous eGFR value (p=0.042). CONCLUSION: Progressive deterioration of renal function each year is frequent in hypertensive diabetic and non-diabetic patients. Beyond aging, this is particularly dependent on BP control particularly at nighttime, on drug therapy, and on highly abnormal glucose control. SN - 1178-2048 UR - https://www.unboundmedicine.com/medline/citation/28721063/Annual_deterioration_of_renal_function_in_hypertensive_patients_with_and_without_diabetes_ L2 - https://dx.doi.org/10.2147/VHRM.S135253 DB - PRIME DP - Unbound Medicine ER -