The message for World Kidney Day 2009: hypertension and kidney disease—a marriage that should be prevented

Abstract

The kidney is both a cause and victim of hypertension. High BP is a key pathogenetic factor that contributes to deterioration of kidney function. Presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension (1). Therefore, treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease (CKD). For this reason, the forthcoming World Kidney Day (WKD) on March 12th 2009 will emphasize the role of hypertension for renal disease. In contrast to a decade ago, today most laboratories around the world report estimated GFR (eGFR) instead of, or in addition to, serum creatinine. This now provides the physician with information about kidney function that is, in general, more informative. As a result, a greater percentage of patients with diabetes or hypertension and their physicians have a better knowledge of their kidney function. Assessment of eGFR as an index of kidney function should be complemented by assessing urine for protein or albumin (preferred). In spite of these laboratory updates, recent data demonstrate that a given patient's knowledge that he or she has CKD is very low. In a recent analysis of almost half a million people in Taiwan who took part in a standard medical screening program, 12% had CKD (2). It was noteworthy that less than 4% of those with CKD were aware of their condition. People with CKD are several times more likely to die from cardiovascular (CV) causes than those without CKD; thus, hypertension is a major risk factor in this context (3). The combination of CKD and hypertension, therefore, is a major public health issue; because of the costly treatments necessary for end-stage renal disease (ESRD), end-stage CKD has also become a substantial burden to health budgets. The frequency of CKD continues to …