Abstract
BackgroundHypertension, especially if poorly controlled, is a key determinant of chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD).AimTo assess hypertension and risk factor management, and determinants of systolic blood pressure control in individuals with CKD and hypertension.Design and settingCross-sectional survey using primary care electronic health records from 47/49 general practice clinics in South London.MethodsKnown effective interventions, management of hypertension and cardiovascular disease (CVD) risk in patients with CKD Stages 3–5 were investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure control status as outcome. Individuals with diabetes were excluded.ResultsAdults with CKD Stages 3–5 and hypertension represented 4131/286,162 (1.4%) of the total population; 1984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed hypertension, 23.0% had systolic blood pressure > 140 mmHg compared with 39.8% hypertensives, p < 0.001. Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years. African ethnicity and obesity were associated with poorer systolic blood pressure control.ConclusionWe found both underdiagnosed CKD and underdiagnosed hypertension in patients with CKD. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases.Graphic abstract
Highlights
The population consisted of 286,162 adults followed in 47/49 GP practices in Lambeth 4131 patients out of 286,162 individuals (1.4%) had chronic kidney disease (CKD) and hypertension, nearly half of them (48%, n = 1984) had undiagnosed CKD, as defined by estimated glomerular filtration rate (eGFR) < 60 ml/min in at least two determinations, without a recorded CKD diagnosis
Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, and the presence of comorbidities that are probably associated with a more strict patient control; these include serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years
The main result of this study was to find a high prevalence of underdiagnosed CKD and underdiagnosed hypertension in patients with CKD
Summary
CKD and hypertensionThe diagnosis of chronic kidney disease (CKD) is mainly based on estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 for at least 3 months, even if the broader definition includes all persistent alterations of renal morphology and of blood or urine composition [1]. Key risk factors for CKD include hypertension, cardiovascular disease (CVD), and diabetes [2], and CKD is associated with significant morbidity and mortality, in particular in these groups [2, 3]. The treatment of CKD Stage 3–5 poses a considerable financial burden, and the lifetime the lost health-related quality of life is estimated as £7.18 billion in England [5] This includes the high cost of renal replacement therapy (RRT) for survivors with end-stage renal disease and cardiovascular disease complications. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases
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