Clinical Investigation

Kidney International (1989) 35, 670–674; doi:10.1038/ki.1989.37

Progression of renal insufficiency: Role of blood pressure

Peter C Brazy, William W Stead and James F Fitzwilliam

Nephrology Division and Department of Medical Information Systems, Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina, USA

Correspondence: Peter C Brazy MD, Nephrology Section H4/510, University of Wisconsin Clinical Science Center, 600 Highland Avenue, Madison, Wisconsin 53792, USA.

Received 2 March 1988; Revised 12 September 1988.

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Abstract

Progression of renal insufficiency: Role of blood pressure. The effect of blood pressure on progression of renal insufficiency was examined in a large group of patients who eventually required dialysis. Out of 198 consecutive new chronic dialysis patients, 86 had sufficient data predi alysis to determine rates of progression of renal insufficiency by reciprocal creatinine versus time plots. Average plasma creatinine at first contact was 3.8 plusminus 0.2 mg/dl and at the time of dialysis was 11.4 plusminus 0.4 mg/dl. Mean duration of follow-up was 33.4 plusminus 2.5 months and the average rate of decline in reciprocal creatinine was -0.009 plusminus 0.001 di! mg month. Patients were stratified by average value of diastolic blood pressure measured in clinic. Patients in the lowest quartile had a rate of decline in reciprocal creatinine of -0.007 plusminus 0.001 dl/mg month, which was slower than that of patients in the third and fourth quartiles, -0.010 plusminus 0.001 and -0.011 plusminus -0.002 dl/mg month, respectively (P < 0.05). In individual patients, a mean diastolic BP of <90 mm Hg was associated with a rate of decline in reciprocal creatinine of -0.006 plusminus 0.001 dl/mg month which was significantly less than the rate of -0.009 plusminus 0.001 when the diastolic BP was >90 mm Hg. Thus, in a large group of patients who have progressed to ESRD, there is an associatiOn between control of diastolic blood pressure and a slower rate of decline in renal function.

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