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Kidney Int., Dec 28 2023, S0085-2538(23)00918-3 | https://doi.org/10.1016/j.kint.2023.12.008 Findings from the KNOW-CKD Study indicates that higher systolic blood pressure time in target range is associated with a lower risk of chronic kidney disease progression

Cheol Ho Park MD, PhD ¹, Hyung Woo Kim MD ¹, Young Su Joo MD, PhD ^1,2, Jung Tak Park MD, PhD ¹, Tae Ik Chang MD, PhD ³, Tae-Hyun Yoo MD, PhD¹, Sue Kyung Park MD, PhD ⁴, Yeong Hoon Kim MD, PhD ⁵, Suah Sung MD, PhD ⁶, Young Youl Hyun MD, PhD ⁷, Kook-Hwan Oh MD, PhD ⁸, Shin-Wook Kang MD, PhD ¹, Seung Hyeok Han MD, PhD ¹ on the behalf of KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease) Investigators

¹Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea

²Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea

³Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Republic of Korea

⁴Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

⁵Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea

⁶Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Republic of Korea

⁷Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea

⁸Department of Internal Medicine, Seoul National University Hospital, Kidney Research Institute, Seoul, Republic of Korea

Corresponding author: Seung Hyeok Han

Abstract

Time-in-target range (TTR) of systolic blood pressure (SBP) is determined by the proportion of time during which SBP remains within a defined optimal range. TTR has emerged as a useful metric for assessing SBP control over time. However, it is uncertain if SBP-TTR can predict the progression of chronic kidney disease (CKD). Here, we investigated the association between SBP-TTR during the first year of enrollment and CKD progression among 1758 participants from the KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease). Baseline median estimated glomerular filtration rate (eGFR) was 51.7 ml/min per 1.73 m ². Participants were categorized into four SBP-TTR groups (0%, 1-50%, 51-99%, and 100%). The primary outcome was CKD progression defined as 50% or more decline in eGFR from baseline measurement or the initiation of kidney replacement therapy. During the follow-up period (9212 person-years over a median 5.4 years), the composite outcome occurred in 710 participants. In the multivariate cause-specific hazard model, a one-standard deviation increase in SBP-TTR was associated with an 11% lower risk of the composite outcome with hazard ratio, 0.89 (95% confidence interval, 0.82-0.97). Additionally, compared to patients with SBP-TTR 0%, the respective hazard ratios for those with SBP-TTR 1-50%, 51-99%, and 100% were 0.85 (0.68-1.07), 0.76 (0.60-0.96), and 0.72 (0.55-0.94), and the respective corresponding slopes of eGFR decline were -3.17 (-3.66 to -2.69), -3.02 (-3.35 to -2.68), -2.62 (-2.89 to - 2.36), and -2.33 (-2.62 to -2.04) ml/min/1.73 m ² . Thus, higher SBP-TTR was associated with a decreased risk of CKD progression in patients with CKD.

논문정보

형식Research article
게재일2023년 12월 (BRIC 등록일 2024-01-04)
연구진국내 연구진
분야 의약학 > 응용의학

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