Systolic Blood Pressure in CKD Grades 4-5 and Risk of Kidney Replacement Therapy and Mortality

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Background: In patients with chronic kidney disease grade 4 and 5 (CKD G4-5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control <120 mmHg are associated with kidney replacement therapy (KRT) and mortality. Methods: In a retrospective cohort study, hypertensive CKD G4-5 patients attending the Renal Health Clinic at the Hospital Civil de Guadalajara were enrolled. We divided them into those that achieved SBP < 120 mmHg (controlled) and those who did not (>120 mmHg), the uncontrolled. Our primary objective was to analyze the association between the controlled group and KRT; the secondary objective was the mortality risk, and if there were subgroups of patients that achieved more benefit. Results: A total 275 hypertensive CKD G 4-5 patients were included, 62 in the controlled and 213 in the uncontrolled group; mean age 61 years, SBP was lower in the controlled group (111 mmHg) compared to the uncontrolled group (140 mmHg), eGFR was similar (20.41 ml/min/1.73m2). There was a tendency to increase the mortality risk in the uncontrolled group (OR 6.4, p= 0.082) and an association by the Kaplan-Meir analysis (Log-rank p= 0.043). The subgroup analysis for risk of KRT in the controlled group revealed that patients ≥ 61 years had a lower risk of KRT (OR 0.87, p=0.03, p of interaction = 0.005), but no differences were found in the subgroup analysis for mortality. Before propensity score matching, no association was found in the risk of KRT in a multivariate analysis. Conclusions: In a retrospective cohort of patients with CKD G4-5 and hypertension, SBP >120 mmHg was not associated with risk of KRT but could increase the risk of death.

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