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CARDIOVASCULAR RISK FACTORS, BLOOD PRESSURE CONTROL, AND KIDNEY FUNCTION PROGRESSION AMONG CHRONIC KIDNEY DISEASE POPULATION.
Jafar Al-Said, M.B. CHb. MD. FASN, FACP. Teerath Kumar MBBS. FCPS. Soni Murdeshwar.Bahrain Specialist Hospital
Introduction:Patients with HTN and CKD has increased CV risk factors. CKD OPD population at Bahrain Specialist Hospital were analyzed.
Aim: study our CKD population regarding: • CV risk profile.• HTN prevalence & treatment.• Kidney function progression.Methodology: * Retrospective. * OPD population with CKD. * 102 months. Oct. 2003 – April 2012.
Data: Demographic, CV risk & medications.Estimate eGFR by CKD EPI.
Exclude: Transplant, Pregnant, Primary GN.
Results: * Mean age 58.7 y (SE 0.9). * Males 61%
Kidney function outcome
Final BP control:
Type of medications used
Number of medication needed to keep BP <140/90
Prevalence of CV Risks among CKD
Relation of the number of CV risk & CKD stage
Cumulative numbers of CV risk factors in CKD
Conclusion: Among our CKD patients:- HTN is the most Common CV risk factors.- CV risk factors increase with CKD stage.- 58% needed combination antiHTN Medications.- CKD progression was stable over 108 months.- Final eGFR was correlated with: Gender, DM, systolic BP, Albumin, Ca blocker, Vasodil. & NTG.
Univariat correlation with eGFR progression
Uncontrolled
Controlled
43%
57%
1 2 3 4 5 6 7 80%5%
10%15%20%25%30%
5%
11%
18%
24%
17% 18%
6%1%
Mean = 4
HTN
Hyperlipi.
DM
Hyperu
ric.
IHD
PVDStr
oke0%
20%40%60%80%
100%
91%72%
60%
43%20% 9% 6%
I II III IV V1
2
3
4
2.5 2.4
3.1 3.23.5
P = 0.001
0 1 2 3 4 5 60%
10%
20%
30%
40%
12%
30% 36%
12% 7%2% 1%
RAAS
Diuretics
B-Blocker
Alpha/Beta
blo.
Ca Block
er
Alpha Blocker
Vasodila
tor
NTG
0%15%30%45%60% 61%
29%38%
14%
41%
3%10% 14%
CARDIOVASCULAR RISK FACTORS, BLOOD PRESSURE CONTROL, AND KIDNEY FUNCTION PROGRESSION AMONG CKD POPULATION.
Jafar Al-Said, M.B. CHb. MD. FASN, FACP. Teerath Kumar MBBS. FCPS. Soni Murdeshwar
23rd Annual European Society of Hypertension meeting. Milan. 16. June. 2013
Introduction• Patients with HTN and CKD have increased CV risk
factors.
• Different population have different CV risk profile.
• Determining the CV risk factors will help in planning a preventive protocol for these patients.
• We wanted to identify the CV risk for our CKD population at Bahrain Specialist Hospital.
Aim• Determine the CV risk profile among our
CKD population.
• Identify HTN prevalence in that cohort. & their treatment.
• Determine the progression of CKD among these patients an their related factors.
Methodology
Retrospective. • OPD population with CKD. • 102 months. Oct. 2003 – April 2012.
Data: Demographic, CV risk & medications.Estimate eGFR by CKD EPI.
Exclude: Transplant, Pregnant, Primary GN.
Results
Total CKD population = 245 .
Total CKD and HTN = 223.
Mean age 58.7 y (SE 0.9).
Males 61%.
Cardiovascular risk factors Total CKD population, n = 245
HTN Hyperlipi. DM Hyperuric. IHD PVD Stroke0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%91%
72%
60%
43%
20%9%
6%
Type of CV disease
Total CV risk including Age, Gender & BMI
1 2 3 4 5 6 7 80%
5%
10%
15%
20%
25%
30%
5%
11%
18%
24%
17% 18%
6%
1%
Mean = 4
Cumulative number of CV risks
Mean number of CV risk factors according to CKD stage.Other than CKD.
I II III IV V1
1.5
2
2.5
3
3.5
4
2.5 2.4
3.1 3.2
3.5P = 0.001
Mea
n N
umbe
r of
CV
ri
sk fa
ctor
s
CKD staging
Blood Pressure Control < 140/90mmHg
43%
57%Controlled
Uncontrolled
Number of Anti HTN medications needed to control BP <140/90mmHg in CKD & HTN
0 1 2 3 4 5 60%
5%
10%
15%
20%
25%
30%
35%
40%
12%
30%
36%
12%
7%
2% 1%
Number of Anti HTN Medications
RAAS
Diuretics
B-Blocker
Alpha/Betab
locker
Ca Blocke
r
Alpha Blocke
r
Vasodila
torNTG
0%
10%
20%
30%
40%
50%
60%
70%61%
29%
38%
14%
41%
3%10%
14%
Antihypertensive drugs used in the HTN group
`Progression of kidney function among HTN CKD population
Variables Correlation Coefficient PGender -0.29 <0.0001DM -0.19 0.006First Systolic -0.15 0.03First Hb 0.44 <0.0001First Albumin 0.27 0.003Final Albumin 0.21 0.04Ca Channel -0.16 0.023Vasodilator -0.23 0.001NTG -0.21 0.002
Independent Univariate Correlated Variables with final eGFR.
Final Conclusion• CKD patient carry high CV risk factors.
• HTN is the most common CV risk factor among CKD population.
• 57 % of the HTN CKD were controlled after 2 years of follow up.
• 58% of the CKD and HTN patient needed > AntiHTN medication to control BP.
• Kidney function was stable over 2 years.