Strict BP Control May Reduce Mortality from ESRD

Although strict BP control doesn’t slow progression from chronic kidney disease (CKD) to ESRD, it is associated with a lower risk of death after ESRD develops, reports a study in Kidney International.

The study presents extended follow-up of patients enrolled in the Modification of Diet in Renal Disease (MDRD) trial. In that study, 840 patients with CKD were assigned to strict or usual BP control; the mean arterial pressure targets were less than 92 mm Hg versus 107 mm Hg, respectively. The occurrence of ESRD and death were determined by linkage to the U.S. Renal Data System and National Death Index.

At a median follow-up time of 19.3 years, ESRD developed in 627 patients, with no significant difference between the two BP strategies. A median of 10 years after the occurrence of ESRD, there were 142 deaths in the strict control group versus 182 in the usual control group: 4.4 versus 6.1 deaths per 100 person-years, respectively.

With strict control, the unadjusted hazard ratio for death after the onset of ESRD was 0.72. On analysis regardless of ESRD status, strict BP control was also associated with a lower risk of death. Patients in the usual care group were more likely to have coronary artery disease and congestive heart failure at the time of ESRD diagnosis.

Few studies have examined how BP control and other CKD treatments affect clinical outcomes after ESRD develops. The new study suggests that patients receiving strict control have a lower long-term risk of death after incident ESRD. Further studies are needed to confirm this finding and its relationship to cardiovascular health status at ESRD onset [Ku E, et al. Association between strict blood pressure control during chronic kidney disease and lower mortality after onset of end-stage renal disease. Kidney Int 2015; 87:1055–1060].