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.