Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study Public Deposited

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  • March 21, 2019
Creator
  • Hardy, Shakia
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • While much of the chronic kidney disease (CKD) literature examines the role of elevated blood pressure in CKD progression, little is known about the benefits of modest decrements in blood pressure on incident CKD and kidney failure (KF). We estimated the impact of 2 pragmatic interventions hypothesized to reduce the incidence of CKD and KF: (1) a population‐wide intervention that reduced systolic blood pressure (SBP) by 2 mmHg and (2) targeted interventions that reduced the prevalence of blood pressure above clinical management goals by 10%. Analyses included 15,744 participants of the Atherosclerosis Risk in Communities Study (45-64 years of age at baseline, 1987-1989). Incident CKD and KF were ascertained from laboratory assays and abstraction of hospital records. Over a mean of 20 years of follow up 3,852 and 954 incident CKD and KF events were ascertained. After adjustment for antihypertensive use, gender, diabetes and age, a population-wide 2 mmHg decrement in SBP was associated 23.5 (95% CI: 12.3-34.6) and 26.8 (95% CI: 20.6-33.1) fewer incident CKD events and 20.1 (95% CI: 12.4-27.8) and 9.3 (95% CI: 6.0-12.5) fewer incident KF events per 100,000 person years (PY) in African Americans (AAs) and white Americans (WAs), respectively. A 10% proportional decrease of participants with blood pressure above JNC 7 goal was associated with 16.1 (95% CI: 10.0-24.3) and 7.8 (95% CI: 5.6-10.2) fewer incident CKD events, and 12.5 (95% CI: 7.8-17.6) and 2.5 (95% CI: 1.3-3.7) fewer incident KF events per 100,000 PY in AAs and WAs. KF was associated with 12,873 disability adjusted life years (DALYs). A 2 mmHg reduction in SBP was estimated to reduce DALYs associated with KF by 37.5 and 14.0 DALYs in AAs and WAs respectively, while reduction of blood pressure above goal was associated with 23.5 and 3.9 fewer DALYs in AAs and WAs. Modest improvements in the level of SBP and blood-pressure-above-goal are predicted to decrease both the incidence of CKD and KF, and the number of DALYs associated with KF. AAs, who bear a disproportionate burden of KF and its associated disability, could benefit from blood pressure reduction strategies more than WAs.
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  • In Copyright
Advisor
  • Viera, Anthony
  • Kshirsagar, Abhijit
  • Heiss, Gerardo
  • Zeng, Donglin
  • Avery, Christy
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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