Renal Function In Hypertensive Patients Research Articles

Threshold-modifying effect of the systemic inflammatory response index on kidney function decline in hypertensive patients

BackgroundChronic kidney disease (decreased kidney function) is common in hypertensive patients. The SIRI is a novel immune biomarker. We investigated the correlation between the SIRI and kidney function in hypertensive patients.MethodsThe present study analyzed data from participants who suffered from hypertension in the NHANES from 2009 to 2018. Multivariate regression analysis and subgroup analysis were used to clarify whether the SIRI was an independent risk factor for decreased kidney function. RCSs were utilized to evaluate the correlation between the SIRI and the eGFR and between the SIRI and the ACR. In addition, we modeled the mediating effect of the SIRI on the eGFR and the ACR using blood pressure as a mediating variable.ResultsThe highest SIRI was an independent risk factor for a decreased eGFR [odds ratio (OR) = 1.46, 95% CI (1.15, 1.86)] and an increased ACR [OR = 2.26, 95% CI (1.82, 2.82)] when the lowest quartile was used as the reference. The RCS results indicated an inverted U-shaped relationship between the SIRI and the eGFR and between the SIRI and the ACR (the inflection points were 1.86 and 3.09, respectively). The mediation effect analysis revealed that the SIRI was the main factor influencing kidney function, and diastolic blood pressure was a mediating variable. In particular, there was a fully mediating effect between the SIRI and UCr, with a mediating effect value of -0.61 (-0.90, -0.36).ConclusionsThe association between the SIRI and renal function in hypertensive patients was significant and was particularly dominated by the association between the SIRI and the ACR. This difference may be due to the mediating effect of diastolic blood pressure.

Renal Function in Hypertensive Patients Receiving Cilnidipine and L-Type Calcium Channel Blockers: A Meta-Analysis of Randomized Controlled and Retrospective Studies

Nearly 65%-95% of chronic kidney disease (CKD) patients have hypertension. Calcium-channel blockers are the first-line drugs for the treatment of hypertension, including hypertension with diabetes. This study aims to estimate the effect of an L-type calcium channel blocker (CCB), cilnidipine, on the renal function of hypertensive patients. Randomized control trials were selected from PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), Science Direct, Elton B. Stephens Company (EBSCO), Springer, Ovid, Cochrane Library, Medline, VIP, and Wanfang databases (from the date of databases' establishment till January 2022). Data were independently evaluated following the Cochrane risk-of-bias tool. The changes in serum creatinine (SCr), urinary protein excretion (UPE), urinary protein/creatinine ratio (UPCR), and estimated glomerular filtration rate (eGFR) before and after treatment, in percentages, were extracted for the meta-analysis. The mean difference (MD) and a CI of 95% were determined using RevMan 5.3 software. A total of 11 studies were analyzed. The standardized mean difference (SMD) between cilnidipine and L-type CCBs was -0.022, suggesting a reduced SCr with cilnidipine. For UPCR, the SMD value is 1.28. Although cilnidipine reduced UPCR in all four studies, the L-type CCBs reported a slight increase in UPCR. For eGFR, the SMD value was found to be 0.693. Cilnidipine had a more favorable effect on eGFR when compared to the L-type CCBs. While cilnidipine had similar effects on SCr to that of L-type CCBs, cilnidipine showed greater improvement in UPCR, UPE, and eGFR values.

Chronic Pain and Its Association with Depressive Symptoms and Renal Function in Hypertensive Patients.

Chronic pain is a common concern and is considered to be one of the major problems in patients with chronic physical disorders. We studied the effect of pain in patients with hypertension with or without chronic kidney disease (CKD) and the association between pain and symptoms of depression. The study involved 158 hypertensive individuals (59.5% male, mean age 55 years), of whom 47 (29.8%) had CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). Pain was assessed with the pain/discomfort domain of the EuroQol-5 D, while depressive symptoms were assessed with the depression module of the Patient health questionnaire (PHQ-9). The prevalence of chronic pain in our sample was 44.3%. Women exhibited chronic pain more often compared to men (57.1% vs. 42.9%, p < 0.001). The presence of CKD was not significantly associated with a higher prevalence of chronic pain among hypertensive patients. Depressive symptoms were significantly associated with the presence of chronic pain. These findings were confirmed in the logistic regression analysis. Chronic pain is common in hypertensive individuals and the association with depression warrants further investigation and may have practical implications in managing these patients.

Influence of viscersal obesity and adipokin status on the rsenal function in hyperstensive patients with obesity and chrsonic hearst failurse

THE AIM: to evaluate the effect of visceral obesity, adipokine status on the functional state of the kidneys in patients with arterial hypertension (AH), obesity, and chronic heart failure (CHF).PATIENTS AND METHODS. 383 AH patients aged 45-70 years were divided into four groups: group 1 - persons with AH without obesity and CHF, group 2 - AH + obesity without CHF, group 3 - AH + obesity + CHF, group 4 - AH + CHF without obesity. A clinical examination was carried out, the indicators of visceral obesity, adipokine status, and functional state of the kidneys were assessed. In addition to descriptive statistics, comparison of groups with each other, and correlation analysis, multivariate regression analysis was used with the construction of regression equations.RESULTS. Revealed statistically significant differences between 1 and 2, 1 and 3, 2 and 4, 3 and 4 groups not only in body mass index (BMI) - 23.9 [22.4; 24.3] vs 32.8 [31.1; 36.3], 23.9 [22.4; 24.3] vs 33.6 [30.8; 35.6], 32.8 [31.1; 36.3] vs 24.1 [23.1; 24.5], 33.6 [30.8; 35.6] vs 24.1 [23.1; 24.5] kg / m2, respectively, but also by the percentage of visceral fat (7.0 [6.0; 8.0] vs 14.0 [11.0; 16.0] vs 18.0 [14.3; 22.0] vs 8.0 [5.0; 10.0] % in groups 1,2, 3 and 4, respectively - p1-2, p1-3, p2-3, p2-4, p3-4 less than 0,0001, p1-4 = 0.022. The level of leptin in blood serum was significantly lower in group 1 in comparison with 2, 3, 4, and in group 4 in comparison with 3 (6.9 [6.6; 22.7] vs 64.8 [59.3; 70.3], 63.6 [42.0; 86.1], 58.7 [18.9; 73.5] and 58.7 [18.9; 73, 5] vs 63.6 [42.0; 86.1] ng / ml, respectively) The serum adiponectin concentration was statistically significantly higher in group 1 compared with group 2, 3 and in group 4 compared with group 3 (36.6 [29.2; 44.1] vs 18.9 [17.1; 20.6] vs 26.9 [22.2; 32.2] and 36.8 [20.2; 62.8] vs 26,9 [22.2; 32.2] ng / ml, respectively) Visceral obesity index (VAI) was 1.49 [1.24; 2.07] vs 2.58 [2.03; 3.37] vs 3.08 [2.59; 3.84] vs 2.36 [1.81; 3.13] c.u. in groups 1,2, 3, 4, respectively, p1-2 = 0.0007, p1 -4 = 0.0001, p2-3 = 0.017, p1-3 and p3-4 less than 0.00001. There was a significant decrease in the glomerular filtration rate (GFR) in groups 3 and 4 in comparison with group 1 (59.0 [53.0; 67.8] and 69.0 [62.0; 83.0] vs 75.0 [68.0; 96.0] ml / min / 1.73 m2, respectively), as well as in group 3 in comparison with 2 and 4 (59.0 [53.0; 67.8] vs 71.0 [60.0; 86, 5] and 69.0 [62.0; 83.0] ml / min / 1.73 m2, respectively). The level of albuminuria increased with adherence to hypertension of obesity and / or CHF (14.2 [3.7; 44.4] vs 36.9 [13.6; 118.2] vs 149.8 [92.2; 247, 6] vs 72.0 [36.2; 104.7] mg / g in groups 1,2, 3 and 4, respectively, the differences are statistically significant between 1 and 2, 1 and 3, 1 and 4, 2 and 3, 3 and 4 groups). The concentration of p2-microglobulins in urine was significantly lower in group 1 compared with groups 3 and 4 (0.10 [0.05; 0.42] vs 0.25 [0.20; 0.31] vs 0.27 [0,19; 0.31] pg / ml). Correlation analysis revealed the peculiarities of the influence of visceral obesity, adipokine status on the functional state of the kidneys in each of the studied groups.CONCLUSION. The study confirmed the negative effect of visceral obesity, hyperleptinemia, and hypoadiponectinemia on the progressive deterioration of the renal function in hypertensive patients with adherence to obesity and/or CHF.

New Therapeutic Insight into the Effect of Ma Huang Tang on Blood Pressure and Renal Dysfunction in the L-NAME-Induced Hypertension

In this study, we evaluated the effect of a traditional herbal formula, Ma Huang Tang (MHT), on blood pressure and vasodilation in a rat model of NG‐nitro‐L‐arginine methylester- (L-NAME-) induced hypertension. We found that MHT-induced vascular relaxation in a dose-dependent manner in rat aortas pretreated with phenylephrine. However, pretreatment of endothelium-intact aortic rings with L‐NAME, an inhibitor of nitric oxide synthesis (NOS), or 1H‐[1, 2, 4]‐oxadiazole‐[4, 3‐α]‐quinoxalin‐1‐one (ODQ), an inhibitor of soluble guanylyl cyclase, significantly abolished vascular relaxation induced by MHT. MHT also increased the production of guanosine 3′,5′-cyclic monophosphate (cGMP) in the aortic rings pretreated with L-NAME or ODQ. To examine the in vivo effects of MHT, Sprague Dawley rats were treated with 40 mg/kg/day L-NAME for 3 weeks, followed by administration of 50 or 100 mg/kg/day MHT for 2 weeks. MHT was found to significantly normalize systolic blood pressure and decreased intima-media thickness in aortic sections of rats treated with L-NAME compared to that of rats treated with L-NAME alone. MHT also restored the L-NAME-induced decrease in vasorelaxation response to acetylcholine and endothelial nitric oxide synthase (eNOS) and endothelin-1 (ET-1) expression. Furthermore, MHT promoted the recovery of renal function, as indicated by osmolality, blood urea nitrogen (BUN) levels, and creatinine clearance. These results suggest that MHT-induced relaxation in the thoracic aorta is associated with activation of the nitric oxide/cGMP pathway. Furthermore, it provides new therapeutic insights into the regulation of blood pressure and renal function in hypertensive patients.

High Level of Physical Activity Reduces the Risk of Renal Progression in Hypertensive Patients.

Physical activity has long been associated with chronic diseases. However, the association between physical activity and renal progression in hypertensive patients remains unclear. This study investigated the relationship between the level of physical activity and renal function in hypertensive patients. We analyzed 3543 patients with hypertension. Data on patients’ demographic characteristics, comorbidities, physical activity, and lifestyle characteristics were collected via questionnaires. An estimated glomerular filtration rate (eGFR) that was reduced by more than 25% from the baseline eGFR was defined as renal progression. This study divided physical activity into three levels (low, moderate, and high) based on their metabolic equivalent of tasks (METs) levels. The mean age was 63.32 ± 12.29 years. After we adjusted for covariates, renal progression was significantly higher among patients with low levels of physical activity (odds ratio (OR), 1.39; 95% confidence interval (CI), 1.01–1.90)) and moderate levels of physical activity (OR, 1.39; 95% CI, 1.04–1.86) than among patients with high levels of physical activity. We found a significant association between physical activity and renal progression in hypertensive patients, especially in elderly patients and men. Therefore, to reduce the risk of renal progression, we recommend that clinicians should encourage patients to improve their physical activity.

Comparative effect of calcium channel blockers on renal function in hypertensive patients with diabetes mellitus

Comparative effect of calcium channel blockers on renal function in hypertensive patients with diabetes mellitus

Evaluation Cystatin C Levels and Some Factors of Renal Function in Hypertensive Patients

Evaluation Cystatin C Levels and Some Factors of Renal Function in Hypertensive Patients

Effect of Angiotensin-Converting Enzyme Inhibitor/Calcium Antagonist Combination Therapy on Renal Function in Hypertensive Patients With Chronic Kidney Disease: Chikushi Anti-Hypertension Trial - Benidipine and Perindopril.

BackgroundAppropriate blood pressure control suppresses progression of chronic kidney disease (CKD). If an angiotensin-converting enzyme (ACE) inhibitor is ineffective, adding a calcium antagonist is recommended. We compared the long-term effect of two ACE inhibitor/calcium antagonist combinations on renal function in hypertensive patients with CKD.MethodsPatients who failed to achieve the target blood pressure (systolic/diastolic: < 130/80 mm Hg) with perindopril monotherapy were randomized to either combined therapy with perindopril and the L-type calcium antagonist amlodipine (group A) or perindopril and the T/L type calcium antagonist benidipine (group B). The primary endpoint was the change of the estimated glomerular filtration rate (eGFR) after 2 years. Eligible patients had a systolic pressure ≥ 130 mm Hg and/or diastolic pressure ≥ 80 mm Hg and CKD (urine protein (+) or higher, eGFR < 60 min/mL/1.73 m2).ResultsAfter excluding 38 patients achieving the target blood pressure with perindopril monotherapy, 121 patients were analyzed (62 in group A and 59 in group B). Blood pressure decreased significantly in both groups, but there was no significant change of the eGFR. However, among patients with diabetes, eGFR unchanged in group B (n = 37, 59.1 ± 15.1 vs. 61.2 ± 27.9, P = 0.273), whereas decreased significantly in group A (n = 31, 57.3 ± 16.0 vs. 53.7 ± 16.7, P = 0.005).ConclusionsIn hypertensive patients with diabetic nephropathy, combined therapy with an ACE inhibitor and T/L type calcium antagonist may prevent deterioration of renal function more effectively than an ACE inhibitor/L type calcium antagonist combination.

The effect of vasodilator β-blockers on renal function in hypertensive patients.

Not only is there a limited number of studies on the effects of vasodilator β-blocker (VBB) therapy on kidney function - specifically, glomerular filtration rate (GFR), serum creatinine (sCr) and proteinuria - but of those that have been reported, the results are mixed. This meta-analysis seeks to assess the efficacy of VBBs on selected renal parameters in hypertensive patients. We conducted a meta-analysis of any prospective trial that provided both baseline and follow-up of at least 4 weeks of VBB therapy - carvedilol, labetalol, dilevalol, nebivolol and celiprolol in patients with hypertension. We used Ovid MEDLINE, EMBASE and PubMed, all without date restrictions. We included 39 studies totaling 3987 patients. Although VBBs did not significantly change GFR or sCr levels after at least 4 weeks of therapy, they did significantly decrease protein excretion by -0.12 SD units [95% confidence interval (CI) -0.19 to -0.04; P < 0.01]. VBBs did not alter renal blood or plasma flow, but renal vascular resistance (RVR) decreased by -20.03 mmHg min/l (95% CI -28.92 to -11.15; P < 0.01). In the analysis which compared VBBs with non-VBBs, the only significant difference was the greater decrease in RVR in the VBB group by -38.44 mmHg min/l (95% CI -60.57 to -16.31; P < 0.01). VBBs do not affect GFR or sCr levels, but decrease protein excretion. This class of β-blockers, however, is not superior to non-VBBs in reducing proteinuria. VBBs decrease RVR significantly more than non-VBBs.

P1347Long-term effect of statin therapy on annual change in renal function in hypertensive patients

P1347Long-term effect of statin therapy on annual change in renal function in hypertensive patients

Prevalence and Predictors of Renal Dysfunction among Adult Hypertensive Patients Attending Medical Clinic in North-western Tanzania: A Cross Sectional Study

BackgroundHypertension is a known risk factor for the development of renal dysfunction. With the increasing burden of hypertension in developing countries, especially due to lifestyle modifications, we expect a rise in the development of renal dysfunction. The prevalence, pattern and predictors of renal dysfunction among hypertensive patients in sub-Saharan Africa have not been well described.MethodsAn analytical cross-sectional study was conducted at Bugando Medical Centre (BMC) outpatient clinic from February 2013 to April 2013. The primary end point was renal dysfunction defined as an estimated glomerular filtration rate (eGFR) < 90ml/min/1.73m2 (calculated using the Cockroft-Gault equation) and/or the presence of albuminuria.ResultsThe population consisted of more females than males (54.7% vs. 45.3%). The majority of the population came from urban areas. The prevalence of renal dysfunction was found to be 53.9%. Older age, female gender, obesity, high systolic blood pressure and type of antihypertensive medications were found to be strong predictors of renal dysfunction.ConclusionRenal dysfunction was highly prevalent in this population of non-diabetic hypertensive outpatients in North-western Tanzania. This highlights the critical and underappreciated need to monitor renal function in hypertensive patients in sub-Saharan Africa given the increasing high burden of hypertension in the region.

Annual deterioration of renal function in hypertensive patients with and without diabetes.

BackgroundChronic kidney disease (CKD) complicates hypertension and diabetes. Knowledge of the deterioration rate of CKD may anticipate adjustment of therapies with renal elimination. This study evaluates the rate of annual deterioration of renal function in hypertensive patients either with type 2 diabetes (DM2) or without it (non-DM) followed for 5 years and relates it with blood pressure (BP) and glycemic control.Materials and methodsOut of a total of 1924 patients, 1023 patients (594 non-DM and 429 DM2, 53% female, aged 62.1±10.2 years) were evaluated over 5 years for the annual evolution of renal function (estimated glomerular filtration rate [eGFR], Modification of Diet in Renal Disease) ambulatory 24-hour blood pressure and metabolic parameters, corresponding to the analysis of 2378 patient-years.ResultsDM2 and non-DM did not differ for age, mean 24-hour BP levels, nighttime BP, albuminuria, and body mass index. DM2 versus non-DM showed a higher (p<0.02) prevalence of stage 3 CKD (24.0% vs 18.0%, eGFR 30–59), stage 4 (5.4% vs 2.7%, eGFR 15–29), and stage 5 (0.8% vs 0.5%, eGFR <15). Average annual decline of eGFR was 3.3±8.2 in DM2 versus 2.4±7.7 in non-DM (p=0.12, nonsignificant). Annual changes of eGFR and of albuminuria correlated (r=0.578, p<0.001). In multivariate analysis, age, nighttime BP, double inhibition of renin angiotensin system, albuminuria, and HbA1c >8.0% in DM2 predicted the decline in eGFR. On average, 16.2% of DM2 and 13.1% of non-DM moved each year toward a more severe stage of CKD. For initial eGFR <90 mL/min/1.73 m2, 26.4% of DM2 and 18.1% of non-DM patients showed a reduction per year >10% from the previous eGFR value (p=0.042).ConclusionProgressive deterioration of renal function each year is frequent in hypertensive diabetic and non-diabetic patients. Beyond aging, this is particularly dependent on BP control particularly at nighttime, on drug therapy, and on highly abnormal glucose control.

PS 14-45 URIC ACID METABOLISM AND RENAL FUNCTION IN PATIENTS TREATED WITH A FIXED DOSE COMBINATION OF ANTIHYPERTENSIVE MEDICATIONS

Objective: Improvement of serum uric acid (SUA) is thought to have a favorable influence on blood pressure (BP) and renal function in hypertensive patients irrespective of diuretic therapy. The effects of switching therapy to a fixed dose combination (FDC) of losartan (LOS) 50 mg with hydrochlorothiazide (HCTZ) 15 mg (LOS/HCTZ) on BP, UA metabolism, and renal function were assessed in hypertensive patients treated with a FDC of telmisartan (TEL) 40 mg with HCTZ 15 mg (TEL/HCTZ) and compared those of a FDC of TEL with amlodipine (AM) 5 mg (TEL/AM). Design and Method: Sixty-seven hypertensive patients were allocated either LOS/HCTZ (n = 36) or TEL/AM group (n = 31), respectively. Results: Both LOS/HCTZ and TEL/AM were effective in reducing SUA but caused no change in BP after 12 months. LOS/HCTZ increased percent fractional excretion of UA (FEUA) but caused no change in estimated glomerular filtration rate (eGFR). TEL/AM increased eGFR, but trend for increase in FEUA was not significant. Although UA metabolism improved, urinary albumin/creatinine excretion ratio (UACR) increased in two groups. The increase in UACR of TEL/AM was greater than that of LOS/HCTZ. The change in UACR was positively correlated with the changes in eGFR but not with SUA or FEUA. Conclusions: The switching therapy equally controlled BP and improved UA metabolism. Although both LOS-induced inhibitory action of urate transporter 1 and deletion of HCTZ-induced plasma volume reduction were associated with improvement of UA metabolism in the patients, it did not support the beneficial effect of SUA lowering therapy on renal protection.

Cystatin C Based Evaluation of Renal Function in Hypertensive Patients in Ubth, Benin City

Background: Hypertension is a recognized cause of chronic kidney disease. Hypertension in blacks is most important because it is volume dependent and its ensuing renal complication. The widely accepted marker to assess renal function is creatinine and its estimated glomerular filtration rate. However, this is limited in assessing early renal impairment. This necessitate a need to evaluate other renal markers such as cystatin C. Objective: To measure and compare serum cystatin C and creatinine for early renal impairment among hypertensive patients on treatment. Methodology: A total of 48 hypertensive patients attending cardiology clinic for follow up were recruited in this study. Serum specimen were collected and assayed for creatinine and cystatin C. estimated glomerular filtration (eGFR) rate was calculated for the analytes. The two eGFR were compared in assessing renal function. Results: The BMI, Blood pressure and Abdominal circumference of the subjects were significantly higher than the controls (31.5±7.5kg/m 2 , 144/82mmHg and 102.3cm vs 26.1±4.3kg/m 2 , 116/80mmHg and 93cm) respectively Table 1. The hypertensives had a significantly higher serum levels of creatinine and cystatin C when compared with the controls (105µmol/L vs 88µmol/L and 2.9mg/L vs 1.1mg/L) respectively Table 2. Calculated estimated GFR for both serum creatinine and cystatin C were significantly lower among the subjects (89.1ml/min/1.73m 2 vs 110ml/min/1.73m 2 and 67.7ml/min/1.73m 2 vs 118ml/min/1.73m 2 ). Estimated GFR based on cystatin C was significantly lower than eGFR-Cr among the subjects (67.7ml/min/1.73m 2 vs 89.1ml/min/1.73m 2 ). There was a significant correlation between BMI and eGFR-Cr, abdominal circumference also had a significant correlation with fasting plasma glucose among the subjects and controls. Conclusion: serum levels of cystatin C appears to be a better predictor of GFR among hypertensive patients.

Influencing factors of renal function in hypertensive patients with obstructive sleep apnea-hypopnea syndrome

To investigate the related factors of renal functions in hypertensive patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). A total of 438 hypertensive patients with complain of snoring at night were enrolled in the study from the First teaching Hospital of Xinjiang Medical University during March 2011 and March 2014. The diagnosis of OSAHS was confirmed with polysomnography examination, and the patients were divided into 4 groups according to the apnea hypoventilation index (AHI): hypertensive group (AHI<10/h, n=102), mild OSAHS group (AHI 10-<15/h, n=97), moderate OSAHS group (AHI 15-<30/h, n=149), and severe OSAHS group (AHI≥30/h, n=90). The blood urea, creatinine, eGFR, 24h-urinary total protein (24h UTP), 24h-urinary microalbumin, cystatin C (Cyst C) were measured and compared among groups, and the influencing factors of renal function were analyzed. There were no significant differences in age, gender, body mass index(BMI), 24-hour systolic blood pressure (24hSBP), fasting blood-glucose, high-density lipoprotein cholesterol (HDL-C) among the groups (P<0.05). 24h-UTP and 24h-urinary microalbumin in the severe OSAHS group were higher than those in other groups (P<0.05); and all patients with OSAHS had higher Cyst C levels than those without OSAHS (all P<0.05). Logistic regression analysis showed that BMI (OR=1.486, 95% CI 1.022-2.160) and severe OSAHS (OR=7.138, 95% CI 1.835-27.769) were influencing factors of 24h-UTP; blood pressure (OR=2.368, 95% CI 1.324-4.234) and BMI (OR=1.678, 95% CI 1.263-2.230) were influencing factors of 24h-urinary microalbumin; age (OR=1.998, 95% CI 1.325-3.013), blood pressure (OR=3.202, 95% CI 1.319-7.773) and severe OSAHS (OR=5.462, 95% CI 1.103-27.041) were influencing factors of Cyst C. OSAHS is a risk factor for early renal damage in patients with hypertension. Age, BMI, blood pressure and severe OSAHS may be influencing factors for renal function in hypertensive patients with OSAHS.

Association between uric acid and renal function in hypertensive patients: which role for systemic vascular involvement?

The role of systemic vascular involvement in mediating the association between serum uric acid (SUA) and renal function in hypertension has not been explored. Main purpose of our study was to investigate whether morphofunctional vascular changes, assessed as carotid intima-media thickness (cIMT) and aortic pulse wave velocity (aPWV), might mediate the association between SUA and renal damage. We enrolled 523 hypertensive subjects with or without chronic kidney disease and divided population into tertiles of SUA based on sex-specific cutoff values. cIMT and aPWV were higher in uppermost SUA-tertile patients when compared to those in the lowest ones (all P < .001). Uricemia strongly correlated with cIMT and aPWV at univariate analysis (P < .001) and with cIMT after adjustment for confounders (P < .001). Adjustment for cIMT attenuated the relationship between SUA and estimated glomerular filtration rate (P = .019). Systemic vascular changes seem partially to mediate the association between SUA and renal function in hypertensive patients, regardless of kidney function.

Carotid intima-media thickness and estimated glomerular filtration rate in hypertensive patients

To determine the association between carotid atherosclerosis and renal function in hypertensive patients. A total of 2 809 hypertensive patients aged (56.59±10.79) years were enrolled. Carotid intima-media thickness (cIMT) was derived via B-mode ultrasonography and chronic kidney disease (CKD) was evaluated by the estimated glomerular filtration rate (eGFR) with Cockcroft- Gault method. The patients were divided into 3 groups: a normal group, a thick group, and a plaque group according to the results of carotid ultrasonography. The eGFR of the normal group was (111.09±25.61) mL/(min.1.73m(2)), that of the thick group and the plaque group was (94.45±27.14) mL/(min.1.73m(2)) and (85.98±26.92) mL/ (min.1.73m(2)). Binary logistic analysis showed that age (OR=3.590), smoking status (OR=1.543), systolic blood pressure (OR=1.018), diastolic blood pressure (OR=0.977), fasting plasma glucose (OR=1.132), triglyceride (OR=0.873) and eGFR (OR=0.986) were significantly correlated with cIMT. Subgroup analyses on different genders showed that eGFR was a significant independent risk factor in men (OR=0.991) but not in women. The thicker the cIMT, the lower the eGFR in hypertensive patients. With the development of cIMT, eGFR gradually decreases and contributes to the occurrence and development of early-stage atherosclerosis in hypertensive patients.

Echocardiographic parameters and renal function in hypertensive patients with chronic kidney disease: the cardio-renal connection

Echocardiographic parameters and renal function in hypertensive patients with chronic kidney disease: the cardio-renal connection

Increased Uric Acid Promotes Decline of the Renal Function in Hypertensive Patients: A 10-year Observational Study

Uric acid (UA) has shown to be a causal risk factor for the development and progression of renal disease. The aim of this study was to investigate the relationship between changes in the level of UA and trends in the renal function among hypertensive patients during a 10-year observation period. The subjects included 104 hypertensive outpatients (60 women and 44 men, mean age 60±9 (SD) years at the first visit) who had undergone at least five instances of successful 24-hour home urine collection, with the first examination completed between 1998 and 2000 and the last examination completed between 2008 and 2010. The estimated glomerular filtration rate (eGFR) significantly decreased over the 10.4-year observation period, with an average change in eGFR of -0.66/mL/min/year. The uric acid clearance at the last examination was significantly lower than that observed at the first visit, while there were no significant differences in the serum UA levels during this period. The change in serum UA exhibited a significant negative correlation with the change in eGFR (r=-0.34, p<0.01). The patients whose UA level decreased more than 0.5 mg/dL during the observation period demonstrated significantly smaller declines in eGFR compared to those whose UA level increased more than 0.5 mg/dL. In the multivariate analysis, the change in serum UA and the average urinary salt excretion during the observation period were found to be significantly associated with the change in eGFR, independent of age, sex, BP changes or an increased number of antihypertensive drugs. Based on the findings observed over a 10-year observation period, increased UA is suggested to promote decline of the renal function in hypertensive patients. Controlling the level of UA as well as intensively restricting salt intake is required in order to preserve the renal function.