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NDT Advance Access published online on November 4, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp534
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© The Author 2009.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Incident chronic kidney disease and the rate of kidney function decline in individuals with hypertension

Rebecca Hanratty1, Michel Chonchol2, L. Miriam Dickinson3, Brenda L. Beaty3, Raymond O. Estacio1, Thomas D. MacKenzie1, Laura P. Hurley1, Stuart L. Linas1,2, John F. Steiner4 and Edward P. Havranek1

1 Denver Health, Denver, CO 80204, USA 2 Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA 3 Colorado Health Outcomes Program, Aurora, CO 80045, USA 4 Institute for Health Research, Kaiser Permanente of Colorado, Legacy Highlands, Denver, CO 80237, USA

Correspondence and offprint requests to: Rebecca Hanratty; E-mail: Rebecca.hanratty{at}dhha.org



  Abstract

Background. Little is known about the decline of kidney function in patients with normal kidney function at baseline. Our objectives were to (i) identify predictors of incident chronic kidney disease (CKD) and (ii) to estimate rate of decline in kidney function.

Methods. The study used a retrospective cohort of adult patients in a hypertension registry in an inner-city health care delivery system in Denver, Colorado. The primary outcome was development of incident CKD, and the secondary outcome was rate of change of estimated glomerular filtration rate (eGFR) over time.

Results. After a mean follow-up of 45 months, 429 (4.1%) of 10 420 patients with hypertension developed CKD. In multivariate models, factors that independently predicted incident CKD were baseline age [odds ratio (OR) 1.13 per 10 years, 95% confidence interval (CI), 1.03–1.24], baseline eGFR (OR 0.69 per 10 units, 95% CI 0.65–0.73), diabetes (OR 3.66, 95% CI 2.97–4.51) and vascular disease (OR 1.67, 95% CI 1.32–2.10). We found no independent association between age, gender or race/ethnicity and eGFR slope. In patients who did not have diabetes or vascular disease, eGFR declined at 1.5 mL/min/1.73 m2 per year. Diabetes at baseline was associated with an additional decline of 1.38 mL/min/1.73 m2.

Conclusions. Diabetes was the strongest predictor of both incident CKD as well as eGFR slope. Rates of incident CKD or in decline of kidney function did not differ by race or ethnicity in this cohort.

Keywords: chronic kidney disease; hypertension; progression

Received for publication: 15. 4.09
Accepted in revised form: 17. 9.09


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