INCIDENCE AND RISK FACTORS FOR RAPID DECLINE OF PRESERVED ESTIMATED GLOMERULAR FILTRATION RATE AMONG PATIENTS WITH HYPERTENSION IN A COMMUNITY HOSPITAL
DOI:
https://doi.org/10.55374/jseamed.v7.153Keywords:
Hypertension, Rapid decline kidney function, Incidence, Risk factorsAbstract
Background: Hypertension is the second most common leading cause of chronic kidney disease. Related studies explored the causes of the rapid decline of kidney function in advanced kidney disease. However, the causes of the rapid decline of kidney function in the early stage or preserved function of hypertensionrelated kidney disease are less evident.
Objectives: The study aimed to identify the incidence and associated risk factors for the decline of the glomerular filtration rate (GFR) among patients with hypertension with preserved kidney function, estimated GFR (eGFR) above 60/mL/min/1.73m2, at a community hospital.
Methods: A retrospective cohort study was conducted among patients with hypertension with 2 eGFR measures at least 1 year apart and were identified from all cases attending at the Outpatient Department, Sanam Chai Khet Hospital, Chachoengsao Province. The incidence of the estimated rate of eGFR decline greater than 5 mL/min/1.73m2 yearly (ERGFR5/yr) was determined. In addition, potential risk and protective factors were identified using Poisson Regression.
Results: Of 1,328 patients with hypertension, 53.05% were females. The mean age was 59.68 ± 11.58 years. The mean GFR measure at the 1st visit was 88.71± 14.73 mL/min/1.73m2. The incidence of ERGFR5/yr was 11.1 (95% CI: 10.1-12.3)) per 100-person year. Risk factors were being 60 years or older with an incidence rate ratio (IRR) of 1.4 (95% CI: 1.11-1.77), having diabetes mellitus with an IRR of 1.67 (95% CI: 1.37-2.04) and uncontrolled hypertension with an IRR of 1.15 (95% CI: 1.10-1.20).
Conclusion: The incidence of ERGFR5/yr among renal preserved patients with hypertension was relatively low compared with other studies. Aggressive intervention among patients with comorbidity could reduce the incidence of rapid decline in eGFR.
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References
Stergiou GS, Palatini P, Parati G, O’Brien E, Januszewicz A, Lurbe E, et al. European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J Hyperten 2021; 39: 1293–302. DOI: https://doi.org/10.1097/HJH.0000000000002843
Elliott WJ. Systemic Hypertension. Curr Probl Cardiol 2020; 32: 201–59. DOI: https://doi.org/10.1016/j.cpcardiol.2007.01.002
Aekplakorn W, Sangthong R, Kessomboon P, Putwatana P, Inthawong R, Taneepanichskul S, et al. Changes in prevalence, awareness, treatment and control of hypertension in Thai population, 2004-2009: Thai National Health Examination Survey III-IV. J Hyperten 2012; 30: 1734–42. DOI: https://doi.org/10.1097/HJH.0b013e3283568158
Sakboonyarat B, Rangsin R, Kantiwong A, Mungthin M. Prevalence and associated factors of uncontrolled hypertension among hypertensive patients: A nation-wide survey in Thailand. BMC Res Notes 2019; 12: 380-8. DOI: https://doi.org/10.1186/s13104-019-4417-7
Aekplakorn W. The Thai National Health Examination Survey VI (NHES VI).Accessed June 1, 2022. https://www.hsri.or.th/media/printed-matter/detail/13443
Porapakam Y, Bunayaratpan P. The Thai National Health Examination Survey III (NHES III). Accessed June 1, 2022. https://kb.hsri.or.th/dspace/handle/11228/1256?- show=full
Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, et al. Prevalence and risk factors of chronic kidney disease in the Thai adultpopulation: Thai SEEK study. Nephrol Dial Transplant 2009; 25: 1567–75. Available from: https://academic.oup.com/ndt/article/25/5/1567/1839898 DOI: https://doi.org/10.1093/ndt/gfp669
Perkovic V, Cass A, Patel AA, Suriyawongpaisal P, Barzi F, Chadban S, et al. High prevalence of chronic kidney disease in Thailand. Kidney Int 2008; 73: 473–9. DOI: https://doi.org/10.1038/sj.ki.5002701
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013; 382: 260–72. DOI: https://doi.org/10.1016/S0140-6736(13)60687-X
Chapter 2: Definition, identification, and prediction of CKD progression. Kidney Int Suppl 2013; 3: 63–72.
Ebert N, Bevc S, Bö Kenkamp A, Gaillard F, Hornum M, Jager KJ, et al. Assessment of kidney function: clinical indications for measured GFR. Clin Kidney J 2021;14: 1861-70. Available from: https://academic.oup.com/ckj/article/14/8/1861/6146412 DOI: https://doi.org/10.1093/ckj/sfab042
Levey AS, Inker LA. GFR as the “gold Standard”: Estimated, Measured, and True. Am J Kidney Dis 2016; 67: 9–12. DOI: https://doi.org/10.1053/j.ajkd.2015.09.014
Bai K, Chen R, Lu F, Zhao Y, Pan Y, Wang F, et al. Blood pressure is associated with rapid kidney function decline in a very elderly hypertensive Chinese population. Clin Interv Aging 2020; 15: 1317–23. DOI: https://doi.org/10.2147/CIA.S255640
Sheen YJ. Risks of rapid decline renal function in patients with type 2 diabetes. World J Diabetes 2014; 5: 835. 1 DOI: https://doi.org/10.4239/wjd.v5.i6.835
Shlipak MG, Katz R, Kestenbaum B, Siscovick D, Fried L, Newman A, et al. Rapid decline of kidney function increases cardiovascular risk in the elderly. J Am Soc Nephrol 2009; 20: 2625–30. Available from: www.jasn.org DOI: https://doi.org/10.1681/ASN.2009050546
ICD-10 World Health Organization: international statistical classification of diseases and related health problems: 10th reprint in 2015. http://www.who.int/classifications
International Society of Nephrology “Chapter 2: Definition, identification, and prediction of CKD progression.” Kidney Int Suppl 2013; 3: 63-72. DOI: https://doi.org/10.1038/kisup.2012.65
“StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.”
Nojima J, Meguro S, Ohkawa N, Furukoshi M, Kawai T, Itoh H. One-year eGFR decline rate is a good predictor of prognosis of renal failure in patients with type 2 diabetes. Proceedings of the Japan Academy Series B: Phys Biol Sci 2017; 93: 746–54. DOI: https://doi.org/10.2183/pjab.93.046
Kaewput W, Thongprayoon C, Chewcharat A, Rangsin R, Satirapoj B, Kaewput C, et al. Rate of kidney function decline and factors predicting progression of kidney disease in type 2 diabetes mellitus patients with reduced kidney function: A nationwide retrospective cohort study. Ther Apher Dial 2020; 24: 677-87. DOI: https://doi.org/10.1111/1744-9987.13480
Liang X, Ye M, Tao M, Zheng D, Cai R, Zhu Y, Jin J, He Q. The association between dyslipidemia and the incidence of chronic kidney disease in the general Zhejiang population: a retrospective study. BMC Nephrol; 2020 Dec; 21:1-9. DOI: https://doi.org/10.1186/s12882-020-01907-5
Vaes B, Beke E, Truyers C, Elli S, Buntinx F, Verbakel JY, Goderis G, Van Pottelbergh G. The correlation between blood pressure and kidney function decline in older people: a registry-based cohort study. BMJ Open; 2015; 5(6):e007571. DOI: https://doi.org/10.1136/bmjopen-2015-007571
Bulbul MC, Dagel T, Afsar B, Ulusu NN, Kuwabara M, Covic A, et al. Disorders of lipid metabolism in chronic kidney disease. Blood Purif. 2018;46(2):144-52. DOI: https://doi.org/10.1159/000488816
Beyer-Westendorf J, Kreutz R, Posch F, Ay C. The CHA2DS2-VASc score strongly correlates with glomerular filtration rate and predicts renal function decline over time in elderly patients with atrial fibrillation and chronic kidney disease. Int J Cardiol 2018; 253: 71–7. DOI: https://doi.org/10.1016/j.ijcard.2017.10.110
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