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Acute Declines in Renal Function during Intensive BP Lowering: Implications for Future ESRD Risk

Published on Sep 1, 2017in Journal of The American Society of Nephrology8.547
· DOI :10.1681/ASN.2017010040
Elaine Ku11
Estimated H-index: 11
,
George L. Bakris105
Estimated H-index: 105
(U of C: University of Chicago)
+ 7 AuthorsChi-yuan Hsu52
Estimated H-index: 52
Abstract
The magnitude of decline in renal function that should be tolerated during intensive BP lowering and its association with risk of ESRD are unclear. To determine whether the acute declines in kidney function in the intensive BP lowering arm of two trials in CKD associated with higher risk of ESRD, we performed a retrospective study of 899 African American Study of Kidney Disease and Hypertension (AASK) and 761 Modification of Diet in Renal Disease (MDRD) Trial participants previously randomized to strict versus usual BP control. The predictor was the percentage decline in eGFR (
  • References (28)
  • Citations (17)
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References28
Newest
#1Elaine Ku (UCSF: University of California, San Francisco)H-Index: 11
#2Jennifer J. Gassman (Cleveland Clinic)H-Index: 33
Last. Chi-yuan Hsu (UCSF: University of California, San Francisco)H-Index: 52
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Abstract We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or ...
33 CitationsSource
#1Elaine KuH-Index: 11
#2Dawei XieH-Index: 16
Last. Chi-yuan Hsu (KP: Kaiser Permanente)H-Index: 52
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Measured GFR (mGFR) has long been considered the gold standard measure of kidney function, but recent studies have shown that mGFR is not consistently superior to eGFR in explaining CKD-related comorbidities. The associations between longitudinal changes in mGFR versus eGFR and adverse outcomes have not been examined. We analyzed a subset of 942 participants with CKD in the Chronic Renal Insufficiency Cohort Study who had at least two mGFRs and two eGFRs determined concurrently by iothalamate an...
22 CitationsSource
#1Jeff D. Williamson (Wake Forest University)H-Index: 58
#2Mark A. Supiano (UofU: University of Utah)H-Index: 28
Last. Nicholas M. Pajewski (Wake Forest University)H-Index: 28
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Importance The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. Objective To evaluate the effects of intensive ( Design, Setting, and Participants A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015. Interventions Participants were randomized to an SBP...
401 CitationsSource
#1Jackson T. Wright (Case Western Reserve University)H-Index: 58
#2Jeff D. Williamson (Wake Forest University)H-Index: 58
Last. Walter T. Ambrosius (Wake Forest University)H-Index: 44
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#1Carmen A. Peralta (UCSF: University of California, San Francisco)H-Index: 45
#2Leslie A. McClure (UA: University of Alabama)H-Index: 33
Last. Pablo E. Pergola (University of Texas at Austin)H-Index: 32
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Background— The effect of intensive blood pressure (BP) lowering on kidney function among individuals with established cerebrovascular disease and preserved estimated glomerular filtration rate (eGFR) is not established. Methods and Results— Among 2610 participants randomized to a lower ( 30%) using linear mixed models and logistic regression, respectively. We assessed associations of both treatment and kidney function decline with stroke, major vascular events, and the composite of stroke, deat...
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#1Manjeri A. Venkatachalam (University of Texas Health Science Center at San Antonio)H-Index: 51
#2Joel M. Weinberg (UM: University of Michigan)H-Index: 45
Last. Anil K. Bidani (LUC: Loyola University Chicago)H-Index: 40
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The transition of AKI to CKD has major clinical significance. As reviewed here, recent studies show that a subpopulation of dedifferentiated, proliferating tubules recovering from AKI undergo pathologic growth arrest, fail to redifferentiate, and become atrophic. These abnormal tubules exhibit persistent, unregulated, and progressively increasing profibrotic signaling along multiple pathways. Paracrine products derived therefrom perturb normal interactions between peritubular capillary endotheli...
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#1Elaine Ku (UCSF: University of California, San Francisco)H-Index: 11
#2David V. Glidden (UCSF: University of California, San Francisco)H-Index: 64
Last. Chi-yuan Hsu (UCSF: University of California, San Francisco)H-Index: 52
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There is controversy regarding whether strict blood pressure control is indicated in chronic kidney disease (CKD) since the primary results of randomized controlled trials failed to show any impact on progression of kidney disease with this strategy. However, strict blood pressure control may have other beneficial effects beyond reducing the risk of end-stage renal disease (ESRD), such as lowering mortality after ESRD onset. The Modification of Diet in Renal Disease (MDRD) trial randomized 840 p...
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#1Andrew S. Levey (Tufts Medical Center)H-Index: 129
#2Lesley A. Inker (Tufts Medical Center)H-Index: 37
Last. Josef Coresh (Johns Hopkins University)H-Index: 131
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The US Food and Drug Administration currently accepts halving of glomerular filtration rate (GFR), assessed as doubling of serum creatinine level, as a surrogate end point for the development of kidney failure in clinical trials of kidney disease progression. A doubling of serum creatinine level generally is a late event in chronic kidney disease (CKD); thus, there is great interest in considering alternative end points for clinical trials to shorten their duration, reduce sample size, and exten...
192 CitationsSource
#1Sheldon HirschH-Index: 1
#2Jackie HirschH-Index: 1
Last. Brad H. RovinH-Index: 51
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Background: Blood pressure (BP) reduction in patients with chronic kidney disease (CKD), particularly with a renin-angiotensin system inhibitor (RASI), commonly leads to an initial decrease in glomerular filtration rate. The current clinical guideline, based on studies with single RASIs, is to tolerate an increase in the serum creatinine only up to 30%. This guideline has aptly guided CKD care for over a decade, but should be updated in the contemporary context of more aggressive RASI and diuret...
21 CitationsSource
tem (RAS) such as angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs). A review of 1,102 CKD patients from 12 randomized clinical trials clearly showed that in these cases the initial serum creatinine increase associated with RAS inhibitor-based antihypertensive regimens is also followed by slower disease progression [3] . Note that larger shortterm increases were associated with slower GFR decline in the long term. Thus, as originally suggested by Apperloo...
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#1Didier Collard (UvA: University of Amsterdam)H-Index: 1
#2Tom F. Brouwer (UvA: University of Amsterdam)H-Index: 13
Last. Bert-Jan H. van den Born (UvA: University of Amsterdam)H-Index: 21
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Lowering blood pressure (BP) can lead to an initial decline in estimated glomerular filtration rate (eGFR). However, there is debate how much eGFR decline is acceptable. We performed a post hoc analysis of ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) and SPRINT (Systolic Blood Pressure Intervention Trial), which randomized patients to intensive or standard systolic BP-targets. We determined the relation between initial decline in mean arterial pressure and eGFR. S...
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#1Anila Duni (RMIT: RMIT University)H-Index: 1
#2Evangelia Dounousi (RMIT: RMIT University)H-Index: 1
Last. Vassilios Liakopoulos (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 23
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#1Edouard Fu (KI: Karolinska Institutet)
#2Marco Trevisan (KI: Karolinska Institutet)H-Index: 5
Last. J. J. Carrero (KI: Karolinska Institutet)H-Index: 3
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Background and objectives Data from observational and interventional studies provide discordant results regarding the relationship between creatinine increase after renin-angiotensin system inhibition (RASi) and adverse outcomes. We compared health outcomes among patients with different categories of increase in creatinine upon initiation of RASi in a large population-based cohort. Design, setting, participants, & measurements We performed a retrospective analysis of the Stockholm CREAtinine Mea...
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#1Atsuhisa Sato (International University of Health and Welfare)H-Index: 3
Recently, deleterious effects of aldosterone on the kidney via mineralocorticoid receptors (MRs) have been noted. MR antagonists have been reported to show significant antialbuminuric effects when added to angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers. However, a decrease in the estimated glomerular filtration rate (eGFR) has been reported during MR antagonist treatment. On the other hand, although the eGFR often decreases, significant reductions in total mo...
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Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used primarily to treat hypertension and are also useful for conditions such as heart failure and chronic kidney disease, independent of their effect on blood pressure. This article reviews the indications for ACE inhibitors and ARBs and offers advice for managing their adverse effects, particularly declining renal function and hyperkalemia.
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#1Elaine Ku (UCSF: University of California, San Francisco)H-Index: 11
#2Mark J. Sarnak (Tufts University)H-Index: 81
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Background Our objective was to explore the effect of intensive blood pressure (BP) control on kidney and death outcomes among subgroups of patients with chronic kidney disease divided by baseline ...
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Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficac...
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#2Feng Lin (UCSF: University of California, San Francisco)H-Index: 40
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Introduction Depression is common but underrecognized in patients with chronic kidney disease (CKD), especially among racial/ethnic minorities. We examined the association between depressive symptoms and all-cause mortality (including deaths before and after end-stage renal disease [ESRD]) and whether antidepressant use impacts this association, overall, and by race/ethnicity. Methods We ascertained whether the presence of depressive symptoms, defined by a Beck Depression Inventory II (BDI) scor...
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