Increasing pulse pressure ups CKD progression risk

Elevations in pulse pressure (PP) appears to aggravate the risk of progression of chronic kidney disease (CKD), a recent study has found. PP may be a potential, noninvasive indicator of CKD progression.

The study included 1,042 participants (mean age 64.5 years, 51.6 percent men) with CKD, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² or the presence of proteinuria at baseline. Changes in PP and blood pressure parameters were determined from health records. The primary outcome was CKD progression, defined as an exacerbation of eGFR or urinary protein categories.

Participants were followed for an average of 4.66 years, during which time 241 cases of CKD progression were documented. The resulting incidence rate was 49.8 events per 1,000 person-years.

Cox proportional hazards modelling showed that the likelihood of CKD progression increased by nearly 20 percent per 10-mm Hg increase in PP, even after adjusting for potential confounders (adjusted hazard ratio [HR], 1.17, 95 percent confidence interval [CI], 1.06–1.29; p<0.001).

A similar effect was observed when participants were divided into quartiles of PP. The incidence rates of CKD progression increased from 31.9 per 1,000 person-years in the lowest PP category to 40.5, 47.2, and 90.1 per 1,000 person-years in Q2, Q3, and Q4, respectively.

In turn, Cox risk estimates likewise increased linearly across quartiles, such that participants in the highest PP category were nearly 90-percent more likely to see CKD progression than those in the lowest quartile (HR, 1.87, 95 percent CI, 1.23–2.83; p=0.003 for trend).