Higher Blood Pressure Associated with CKD Progression in Young Adults

Kidney Week 2020

There are few data available on chronic kidney disease (CKD) in young adults, 18 to 40 years of age. Management of blood pressure in that subset of CKD patients is based on extrapolated findings from studies conducted in older adults or children. Alexander J. Kula, MD, and colleagues conducted a study in young adults with CKD to examine the association between blood pressure and adverse outcomes.

Results of the observational study were reported during a virtual poster session as ASN Kidney Week 2020. The poster was titled Blood Pressure in Young Adults with CKD and Associations with Cardiovascular Events and CKD Progression.

The study included 317 patients 21 to 40 years of age who were enrolled in the Chronic Renal Insufficiency Cohort study. Exposures included baseline systolic blood pressure category: ≤120, 120 to 129, ≥130, and per +10 higher.

Outcomes of interest were cardiovascular events (heart failure, myocardial infarction, stroke), death from any cause, and progression of CKD (50% decline in estimated glomerular filtration rate [eGFR] or development of end-stage kidney disease). Cox proportional hazard models were used to examine the associations between baseline systolic blood pressure and the outcomes. Adjusted models included age, race, eGFR, diabetes status, prevalent cardiovascular disease (for cardiovascular event models), and urine to creatinine ratio (for CKD progression).

The incidence rates of heart failure, death, cardiovascular events, and progression of CKD were higher at higher categories of systolic blood pressure. In adjusted models, there was a significant association between systolic blood pressure >130 and cardiovascular events (hazard ratio [HR], 3.32; 95 % confidence interval  [CI], 1.53-7.20) and progression of CKD (HR, 1.63; 95% CI, 1.02-2.59) compared with systolic blood pressure <120. There was also a significant  association between every +10 in systolic blood pressure and CKD progression (HR, 1.13; 95% CI, 1.02-1.26) in adjusted models.

In summary, the researchers said, “There is a graded association of higher systolic blood pressure with greater risk of cardiovascular events and CKD progression in young adults with CKD. Among those with systolic blood pressure >130, 5.8% per year had a cardiovascular event and risk was 3-fold higher compared with systolic blood pressure <120; and 20.7% per year had CKD progression and risk was nearly 2-fold higher. These data suggest that higher systolic blood pressure is an important risk factor for adverse outcomes in young adults with CKD.”

Source: Kula AJ, Bansal N, Prince DK, Flynn JT. Blood pressure in young adults with CKD and associations with cardiovascular events and CKD progression. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2020 (Abstract PO2065), October 22, 2020.