STATUS AND SURVIVAL RISK OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND HYPERTENSION

Abstract

Objective: To provide nationwide data on status of control and survival risk of patients with hypertension and chronic kidney disease in China. Design and method: A total of 39,094 participants aged 35 years and above, without prior cardiovascular disease (CVD), were enrolled from a sub-study of the China Hypertension Survey. CKD defined as presence of impaired kidney function (eGFR of <60 mL/min/1.73m2). Hypertension defined as 140/90 mmHg or higher. CVD events and all-cause mortality, with follow-up from 2018 to 2019. Multivariable Cox proportional hazards models were employed to estimate hazard ratios (HRs) of patients with CKD in Chinese adults with hypertension. Results: The mean age was 56.18 years, and the proportion of women was 54.4%. There were 16 276 adults with hypertension. The estimated proportion of CKD in patients with hypertension were 15.79% in China. The proportions of CKD were 13.22%, 17.26%, 21.64% at stage 1, 2, and 3 hypertension, respectively. Among the adults with hypertension, 21.07%, 63.14%, 13.07%, 2.32%, and 0.4% were at stage 1, 2, 3a, 3b, and 4 to 5 CKD, respectively. In patients with hypertension and CKD, the proportions of combined use of 2 or more antihypertensive drugs were 3.87%, 7.37%, 9.41%, 14.79%, and 10.80%, and the control rate of hypertension were 15.13%, 19.74%, 22.94%, 24.60%, and 21.54% at stage 1, 2, 3a, 3b, and 4 to 5 CKD, respectively. Among the hypertensive patients, after adjusting for age, sex, educational levels, alcohol drinking, smoking, and BMI, people with CKD had 58.8% higher risk of CVD (HR=1.588, 95%CI 1.341–1.881) and 34.3% higher risk in all-cause mortality (HR=1.343, 95%CI 1.138–1.584), compared with people without CKD. Significant higher risk of CVD and mortality at 3a, 3b, 4 to 5 CKD compared with stage 1 CKD. Conclusions: Among Chinese adults with hypertension, the proportion of CKD increased with higher blood pressure. Patients with hypertension and CKD had limited control rates of hypertension and high risks of CVD and all-cause mortality, which need more attention.