ingest cdrApp 2017-08-15T22:09:49.395Z d91e81c8-5a8a-4e8a-976c-cad4e396e5ee modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T22:10:37.638Z Setting exclusive relation modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T22:10:38.239Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2017-08-15T22:10:47.473Z Adding technical metadata derived by FITS modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T22:10:57.091Z Setting exclusive relation addDatastream MD_FULL_TEXT fedoraAdmin 2017-08-15T22:11:06.658Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T22:11:24.560Z Setting exclusive relation modifyDatastreamByValue RELS-EXT cdrApp 2017-08-22T13:53:29.504Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-25T12:57:10.672Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-27T12:57:35.238Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-03-14T10:07:23.146Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-05-18T13:00:10.021Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-11T08:38:00.221Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-18T04:45:25.427Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-16T17:53:04.690Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-27T13:41:15.852Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-12T04:51:35.975Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-21T14:37:23.458Z Shakia Hardy Author Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. Spring 2017 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. Spring 2017 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. Spring 2017 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017-05 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017 Epidemiology Public health Blood pressure; Chronic Kidney Disease; Disability; Hypertension; Kidney Failure; Prevention eng Doctor of Philosophy Dissertation Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health Blood Pressure-related Approaches to Reduce the Burden of Chronic Kidney Disease and Kidney Failure. The Atherosclerosis Risk in Communities (ARIC) study 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. 2017 Epidemiology Public health Blood pressure, Chronic Kidney Disease, Disability, Hypertension, Kidney Failure, Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 Shakia Hardy Creator Department of Epidemiology Gillings School of Global Public Health 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. 2017 Epidemiology Public health Blood pressure; Chronic Kidney Disease; Disability; Hypertension; Kidney Failure; Prevention eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Gerardo Heiss Thesis advisor Christy Avery Thesis advisor Anthony Viera Thesis advisor Donglin Zeng Thesis advisor Abhijit Kshirsagar Thesis advisor text 2017-05 Hardy_unc_0153D_17178.pdf uuid:c6943fee-4f56-4f0f-a5c9-f10d4b445d8c 2019-08-15T00:00:00 proquest 2017-06-30T15:02:16Z application/pdf 1796772 yes