Marina Komaroff
Noven Pharmaceuticals, Inc. USA
Biography:
Abstract:
Question: Is there change in the association between treatment of hypertension and stages of chronic kidney disease (CKD) in American adults from 1999 through 2014?
Background: It is known that hypertension is a comorbid condition of chronic kidney disease (CKD) that can damage the kidneys and accelerate progression ending in kidney failure. The prevalence of CKD has remained relatively flat (13-14%) since 2000, but the prevalence of advanced stages of CKD has increased. Recent studies have suggested a potential relationship between anti-hypertensive medications and kidney damage.
Objective: The goal of this study was to estimate the relationships between treatment of hypertension and chronic kidney disease (CKD) stages among American adults, and determine if the relationships have changed from 1999 to 2014. The role of classes of anti-hypertensive medications in these relationships was also examined.
Methods: The U.S. National Health and Nutrition Examination Survey data sets were analyzed from 1999 to 2014. Inferential analyses to determine the change in relationships between CKD stages and treatment of hypertension was done with multinomial logistic regression models.
Results: The odds of CKD stage 3 versus 1 was greater for treated compared to untreated for hypertension, or the odds ratio was consistently greater than one which was expected. However, the odds ratios increased significantly (p= 0.012 in the model without covariates), and (p= 0.026 in the model with the covariates) over 16-years. For example, in 1999 the odds ratio was 1.34 (95% CI: 0.87, 2.09), and by 2014 increased to 3.42 (95% CI: 2.00, 5.84). This increase in the odds ratios was driven by the increase in prevalence of stage 3 of CKD among treated of hypertension while prevalence of early stages decreased or remained stable. Similarly, from 1999 through 2012 there was significant increase in odds ratios for advanced (3, 4, and 5 combined) versus early CKD stages (1 and 2 combined) among users of Angiotensin Receptor Blockers (ARB) compared to not users of ARB (p=0.0069 for any, and p=0.0023 for poly-therapy users) where the prevalence of advanced CKD stages increased, whereas prevalence of early stages decreased or remained stable among ARB users.
Conclusion: There has been significant increase in the association between treatment for hypertension and advanced CKD stages. Furthermore, it appeared that aggressive pharmacological management of hypertension, particularly with ARB as add-on therapy, may have accelerated kidney damage in American adults; however, this hypothesis requires more investigation.
Public Health Significance: Chronic kidney disease is a public health problem associated with significant mortality and morbidity. However, aggressive medical treatment for hypertension during the last decade may perhaps have had unintended consequences by accelerating kidney damage.