Rationale & Objective: Optimal blood pressure (BP) control is a major therapeutic strategy in the management of chronic kidney disease (CKD). We studied the association between BP and adverse kidney outcomes within a diverse cohort of Koreans with CKD. Study Design: Prospective observational cohort study. Setting & Participants: 2,044 participants from the Korean Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Exposures: Baseline and time-updated systolic BP (SBP) and diastolic BP (DBP). Outcome: A composite kidney outcome of a ≥50% decline in estimated glomerular filtration rate (eGFR) from the baseline value or incident kidney replacement therapy. Analytical Approach: Multivariate cause-specific hazards models and marginal structural models were fitted for baseline and time-updated BP, respectively. Results: During 7,472 person-years of follow-up, the primary composite kidney outcome occurred in 473 participants (23.1%), an incidence rate of 63.3 per 1,000 patient-years. Compared with baseline SBP < 120 mm Hg, the hazard ratios (HRs) for 120-129, 130-139, and ≥140 mm Hg were 1.10 (95% CI, 0.83-1.44), 1.20 (95% CI, 0.93-1.59), and 1.43 (95% CI, 1.07-1.91), respectively. This association was more evident in the model with time-updated SBP, for which the corresponding HRs were 1.31 (95% CI, 0.98-1.75), 1.59 (95% CI, 1.16-2.16), and 2.29 (95% CI, 1.69-3.11), respectively. In the analyses of DBP, we observed that time-updated DBP but not baseline DBP was significantly associated with the composite kidney outcome. Compared to patients with SBP < 120 mm Hg, patients with higher SBP had steeper slopes of eGFR decline. In the model including both SBP and DBP, only SBP was significantly associated with the composite kidney outcome. Limitations: Observational design, unmeasured confounders, and use of office BPs only. Conclusions: In patients with CKD, higher SBP and DBP levels were associated with a higher risk of a composite kidney outcome reflecting CKD progression. SBP had a greater association with adverse kidney outcomes than DBP.
|Number of pages||10|
|Journal||American Journal of Kidney Diseases|
|Publication status||Published - 2021 Aug|
Bibliographical noteFunding Information:
This work was supported by Research Program funded by the Korea Centers for Disease Control and Prevention grants 2011E3300300 , 2012E3301100 , 2013E3301600 , 2013E3301601 , 2013E3301602 , 2016E3300200 , and 2016E3300201 . Funding sources had no role in the design and conduct of study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
The KNOW-CKD Investigators not named in the author list include Dong Wan Chae, MD, and Ho Jun Chin, MD, Seoul National University, Bundang Hospital; Sung Woo Lee, MD, Eulji Medical Center, Eulji University; Kyubeck Lee, MD, and Young Youl Hyun, MD, Kangbuk Samsung Medical Center; Seong Kwon Ma, MD, Eun Hui Bae, MD, and Chang Seong Kim, MD, Chonnam National University Hospital; Yong-Soo Kim, MD, The Catholic University of Korea, Seoul St. Mary's Hospital; Wookyung Chung, MD, and Ji Young Jung, MD, Gachon University, Gil Hospital; Yeong Hoon Kim, MD, Tae Hee Kim, MD, and Sun Woo Kang, MD, Inje University, Pusan Paik Hospital; Yun Kyu Oh, MD, Seoul National University, Boramae Medical Center; and Sue K. Park, MD, Seoul National University. Jee Young Lee, MD, Jung Tak Park, MD, PhD, Young Su Joo, MD, Changhyun Lee, MD, Hae-Ryong Yun, MD, PhD, Tae-Hyun Yoo, MD, PhD, Shin-Wook Kang, MD, PhD, Kyu Hun Choi, MD, PhD, Curie Ahn, MD, PhD, Kook-Hwan Oh, MD, PhD, Suah Sung, MD, PhD, Soo Wan Kim, MD, PhD, Joongyub Lee, MD, PhD, and Seung Hyeok Han, MD, PhD. Research idea and study design: JYL, SHH; data acquisition: CL, JYL, SHH; data analysis/interpretation: H-RY, JTP, JYL, SHH; statistical analysis: YSJ, JYL, SHH; supervision or mentorship: JTP, T-HY, S-WK, KHC, CA, K-HO, SS, SWK, JL, SHH. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. This work was supported by Research Program funded by the Korea Centers for Disease Control and Prevention grants 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, and 2016E3300201. Funding sources had no role in the design and conduct of study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors declare that they had no relevant financial interests. The opinions, results, and conclusions are those of the authors and are independent from the funding and data sources. Received April 11, 2020. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form December 14, 2020.
© 2021 National Kidney Foundation, Inc.
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