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Association of Blood Pressure With the Progression of CKD: Findings From KNOW-CKD Study

 Jee Young Lee  ;  Jung Tak Park  ;  Young Su Joo  ;  Changhyun Lee  ;  Hae-Ryong Yun  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Curie Ahn  ;  Kook-Hwan Oh  ;  Suah Sung  ;  Soo Wan Kim  ;  Joongyub Lee  ;  Seung Hyeok Han 
 AMERICAN JOURNAL OF KIDNEY DISEASES, Vol.78(2) : 236-245, 2021-08 
Journal Title
Issue Date
CKD progression ; blood pressure control ; blood pressure target ; chronic kidney disease (CKD) ; diastolic blood pressure (DBP) ; eGFR decline ; end-stage renal disease (ESRD) ; estimated glomerular filtration rate (eGFR) ; hypertension ; incident ESRD ; renal function ; systolic blood pressure (SBP)
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<120mm Hg, the hazard ratios (HRs) for 120-129, 130-139, and≥140mm 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<120mm 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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Lee, Changhyun(이창현)
Joo, Young Su(주영수) ORCID logo https://orcid.org/0000-0002-7890-0928
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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