Diabetes is the strongest predictor of the development of CKD and decline in renal function among individuals with hypertension, a study found.
Rebecca Hanratty, MD, of Denver Health in Denver, Colo., and colleagues examined data from 10,420 hypertensive adult patients. The race or ethnicity of the cohort was 26.9% African-American, 43.7% Hispanic, and 26.1% white. The cohort had a mean baseline estimated glomerular filtration rate (eGFR) of 98.7 mL/min/1.73 m2.
Over a mean follow-up period of 45 months, CKD developed in 429 patients (4.1%), the authors reported in Nephrology Dialysis Transplantation (2009; published online ahead of print). CKD was 3.7 times more likely to develop in diabetics than nondiabetics.
Each 10-year increment in age at baseline was associated with a 13% increased risk of CKD. Vascular disease at baseline was associated with a 67% increased risk. At baseline, each 10-unit increment in eGFR was associated with a 31% decreased risk of CKD.
Among patients without diabetes or vascular disease, eGFR declined at 1.52 mL/min/1.73 m2 per year. Among diabetics, eGFR declined at a rate of 2.9 mL/min/1.73 m2. For patients with both diabetes and vascular, eGFR declined at a rate of 3.52 mL/min/1.73 m2. The rate of CKD development and renal function decline did not differ by race or ethnicity.
“The presence of vascular disease at baseline in patients with diabetes was additive,” Dr. Hanratty’s group concluded. “Our findings suggest that efforts to prevent the development of CKD should focus on awareness of risk factors for diabetes and vascular disease.”