Hypertension and the development of new onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia.

Yook Chin Chia,Siew Mooi Ching

doi:10.1186/1471-2369-13-173

Abstract

BackgroundLittle is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.MethodsThis is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m2 (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD.ResultsThe incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR (OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007).ConclusionsThe progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population.

Highlights

Little is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, at the primary care level
Previous studies have shown that only a small percentage where 15.6 cases per 100,000 person-years of hypertensive patients develop end-stage renal failure [16,17], it is still one of the most important factors associated with the progression of both diabetic and nondiabetic CKD [18]
Setting The current research is part of a 10-year retrospective cohort study of patients registered with the Department of Primary Care Medicine Clinic at the University of Malaya Medical Centre (UMMC)

Summary

Introduction

Little is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, at the primary care level. Previous studies have shown that only a small percentage where 15.6 cases per 100,000 person-years of hypertensive patients develop end-stage renal failure [16,17], it is still one of the most important factors associated with the progression of both diabetic and nondiabetic CKD [18]. It is important for clinicians to be able to identify patients who are at high risk of developing CKD for intensification of treatment This will help to prevent or delay further deterioration of renal function and to reduce the cardiovascular risk [5,7,8,19]

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