Degree of Joint Risk Factor Control and Onset and Progression of Chronic Kidney Disease in Patients With Hypertension

Objective: There is a reciprocal relationship between hypertension and chronic kidney disease. We aimed to determine if controlling multiple risk factors in combination could decrease the risk of chronic kidney disease in hypertensive patients. Design and method: The study was performed using data from the Kailuan cohort. We investigated the association between the degree of control of multiple risk factors on development of chronic kidney disease and the risk of progression in multivariable-adjusted Cox proportional hazards regression analysis. Results: Development of chronic kidney disease was investigated in 73,256 participants with a mean of 11.80 ± 4.50 years. A significant inverse association was found between the degree of risk factor control and the risk of developing chronic kidney disease in the population with hypertension. Each additional risk factor controlled was correlated with a 12% decline in the risk of incident chronic kidney disease (HR 0.88, 95% CI 0.86–0.90). The risk was higher in women and older individuals with hypertension than in their matched controls. Analysis of progression of chronic kidney disease found a similar inverse association between severity of chronic kidney disease and the degree of risk factor control. Each additional risk factor controlled contributed to a 13% reduction in the risk of progression (HR 0.87, 95% CI 0.84–0.90). Conclusions: This study found a significant inverse relationship between the degree of risk factor control and the risk of development and progression of chronic kidney disease in patients with hypertension. Modification of multiple risk factors had an additive effect in protecting kidney function. The results suggest that stronger preventive strategies are needed in hypertensive populations to alleviate kidney dysfunction.