Blood Pressure and Decline in Kidney Function in Patients With Atherosclerotic Vascular Disease: A Cohort Study

Vlek, Anne L.M.; van der Graaf, Yolanda; Braam, Branko; Moll, Frans L.; Nathoe, Hendrik M.; Visseren, Frank L.J.; SMART Study Group,

doi:10.1053/j.ajkd.2009.07.007

« Previous Next »American Journal of Kidney Diseases
Volume 54, Issue 5 , Pages 820-829, November 2009

Blood Pressure and Decline in Kidney Function in Patients With Atherosclerotic Vascular Disease: A Cohort Study

Anne L.M. Vlek, MD
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Yolanda van der Graaf, MD, PhD
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Branko Braam, MD, PhD
- Department of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Frans L. Moll, MD, PhD
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
Hendrik M. Nathoe, MD, PhD
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
Frank L.J. Visseren, MD, PhD
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Address correspondence to Frank L.J. Visseren, MD, PhD, Department of Vascular Medicine, UMC Utrecht, F 02.126, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
SMART Study Group

Received 12 December 2008; accepted 2 July 2009. published online 07 September 2009.

Background

Increased blood pressure generally is associated with kidney function decrease. We evaluated the rate of kidney function decrease, the effect of blood pressure on kidney function deterioration, and the possible interaction with albuminuria in patients with vascular disease.

Study Design

Prospective cohort study.

Setting & Participants

745 patients with vascular disease from the Second Manifestations of Arterial Disease (SMART) Study.

Factors

Blood pressure, hypertension presence, albuminuria (albumin-creatinine ratio > 27 mg/g).

Outcomes

Rate of kidney function decrease, calculated from the difference between 2 estimated glomerular filtration rate (eGFR) values divided by the individual follow-up time.

Measurements

Participants underwent vascular screening at baseline and after a mean follow-up of 4.5 ± 1.0 years. Rate of kidney function decrease was expressed as annual decrease in eGFR. Linear regression analysis was used to evaluate the relation between blood pressure and eGFR decrease.

Results

Mean baseline eGFR was 79.3 ± 16.3 mL/min/1.73 m², and mean annual decrease in eGFR was 1.00 ± 2.71 mL/min/1.73 m². In 35% of patients, eGFR was stable during follow-up. Albuminuria was present in 100 patients (median albumin-creatinine ratio, 58 mg/g). In patients without albuminuria, age-, sex-, and baseline eGFR–adjusted annual eGFR decrease was 0.86 mL/min/1.73 m², whereas this was 1.89 mL/min/1.73 m² in patients with albuminuria (P < 0.05). In the presence of albuminuria, higher blood pressure was associated with greater eGFR decrease (β = 1.29; 95% CI, 0.73-1.85 for systolic blood pressure and β = 3.86; 95% CI, 2.34-5.38 for hypertension presence). In patients without albuminuria, no association was found between blood pressure and kidney function decrease (β = 0.15; 95% CI, −0.05 to 0.36 for systolic blood pressure and β = 0.12; 95% CI, −0.28 to 0.52 for hypertension presence; P for interaction term < 0.05).

Limitations

Participants might reflect a healthier subgroup of patients with vascular disease. Creatinine was measured only twice.

Conclusions

Kidney function decrease in patients with vascular disease is considerable. Blood pressure is a strong risk factor for eGFR decrease in patients with vascular disease and albuminuria.

Index Words: Hypertension, blood pressure, renal function, epidemiology, vascular disease, albuminuria