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. 2025 Jun 6;20(9):1179-1189.
doi: 10.2215/CJN.0000000760.

BP and Kidney Disease Progression in Advanced CKD: Findings from the Chronic Renal Insufficiency Cohort and KoreaN Cohort Study for Outcome in Patients with CKD Studies

Cheol Ho Park  1   2 , Hyung Woo Kim  1   2 , Jung Tak Park  1 , Tae Ik Chang  3 , Tae-Hyun Yoo  1 , Kook-Hwan Oh  4 , Amanda H Anderson  5 , Wei Yang  6 , Jordana B Cohen  6   7 , Mahboob Rahman  8 , Shin-Wook Kang  1 , Seung Hyeok Han  1 ; on the behalf of CRIC Study and KNOW-CKD Investigators
Collaborators, Affiliations

BP and Kidney Disease Progression in Advanced CKD: Findings from the Chronic Renal Insufficiency Cohort and KoreaN Cohort Study for Outcome in Patients with CKD Studies

Cheol Ho Park et al. Clin J Am Soc Nephrol. .

Abstract

Key Points:

  1. Higher BP was associated with a higher risk of kidney disease progression in patients with CKD G3b–G5.

  2. A stronger association observed with time-updated BP emphasizes the importance of consistently maintaining optimal BP over time.

  3. Further validation through well-designed clinical trials is warranted to determine optimal BP in patients with CKD.

Background: BP control is important in the management of CKD. However, in patients with advanced CKD, the benefits of BP control in delaying the progression of CKD remain uncertain.

Methods: We analyzed 2939 participants with CKD G3b–G5 (eGFR <45 ml/min per 1.73 m2) without KRT from the Chronic Renal Insufficiency Cohort study and the KoreaN Cohort Study for Outcome in Patients with CKD (phase 1). The main predictors were baseline and time-updated systolic BP (SBP) and diastolic BP. The primary outcome was a composite kidney outcome of ≥50% decline in eGFR from baseline measurement or the initiation of KRT. In the analyses, multivariate cause-specific hazards models and marginal structural models were fitted for baseline and time-updated BPs, respectively.

Results: During 17755 person-years of follow-up (median, 4.7 years), the composite outcome occurred in 1627 (55%) participants. Compared with baseline SBP <120 mm Hg, the hazard ratios (95% confidence intervals) for 120–129, 130–139, and ≥140 mm Hg were 1.33 (1.15 to 1.54), 1.48 (1.27 to 1.72), and 1.82 (1.58 to 2.10), respectively. This association was more evident in analysis with time-updated SBP, where the corresponding hazard ratios (95% confidence intervals) were 1.29 (1.09 to 1.54), 1.75 (1.46 to 2.10), and 2.79 (2.36 to 3.29), respectively. Furthermore, the slopes of eGFR decline were –1.20 (–1.36 to –1.04), –1.77 (–1.97 to –1.57), –2.11 (–2.35 to –1.88), and –2.48 (–2.70 to –2.27) ml/min per 1.73 m2 per year for respective baseline SBP categories. Additional analyses with diastolic BP also showed similar results.

Conclusions: In patients with advanced CKD, higher BP levels were associated with a higher risk of CKD progression.

Trial registration: ClinicalTrials.gov NCT00304148 NCT01630486 NCT06322056.

Keywords: BP; CKD; clinical epidemiology; clinical hypertension; hypertension.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/CJN/C299.

References

    1. United States Renal Data System. 2022 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2022.
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