Key result
SBP ≥140 mmHg linked to ~191% greater kidney disease progression risk in IgA nephropathy.
Why the study?
Current guidelines recommend SBP below 120 mmHg in CKD, but the renoprotective effect of intensive BP lowering on IgA nephropathy remains undetermined.
Does intensive blood pressure control (SBP 110-119 mmHg) reduce the progression of kidney disease in patients with IgA nephropathy?
Cohort (n=1,530)
No
Does intensive blood pressure control (SBP 110-119 mmHg) reduce the progression of kidney disease in patients with IgA nephropathy?
Maintaining systolic blood pressure between 110-119 mmHg is associated with the lowest risk of kidney disease progression in IgA nephropathy, with higher risks observed at both lower and higher SBP levels.
Answers are grounded in this paper and cite their sources.
Supports SBP 110-119 mmHg range in IgA nephropathy; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: In chronic kidney disease, current guidelines recommend systolic blood pressure (SBP) below 120 mmHg. However, the renoprotective effect of intensive blood-pressure (BP) lowering on immunoglobulin A nephropathy (IgAN) remains undetermined. We aimed to determine the effect of intensive BP control on the progression of IgAN. METHODS: At Peking University First Hospital, 1530 patients with IgAN were enrolled. An examination of the relationship between baseline and time-updated BP and composite kidney outcomes, defined as development of end-stage kidney disease (ESKD) or a 30% decline in estimated glomerular filtration rate (eGFR), was conducted. Baseline and time-updated BPs were modeled using multivariate causal hazards models and marginal structural models (MSMs). RESULTS: In a median follow-up of 43.5 (interquartile range 27.2, 72.7) months, 367 (24.0%) patients experienced the composite kidney outcomes. No significant associations were found between baseline BP and the composite outcomes. Using MSMs with time-updated SBP for analysis, a U-shaped association was found. In reference to SBP 110-119 mmHg, hazard ratios (95% confidence intervals) for the SBP categories <110, 120-129, 130-139 and ≥140 mmHg were 1.48 (1.02-2.17), 1.13 (0.80-1.60), 2.21 (1.54-3.16) and 2.91 (1.94-4.35), respectively. The trend was more prominent in patients with proteinuria ≥1 g/day and eGFR ≥60 mL/min/1.73 m2. After analyzing time-updated diastolic BP, no similar trend was observed. CONCLUSIONS: In patients with IgAN, intensive BP control during the treatment period may retard the kidney disease progression, but the potential risk of hypotension still needs to be considered.
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Tang et al. (2023) conducted a cohort in IgA nephropathy (n=1,530). Time-updated systolic blood pressure categories vs. SBP 110-119 mmHg was evaluated on Composite of end-stage kidney disease (ESKD) or a 30% decline in estimated glomerular filtration rate (eGFR) (HR 2.91, 95% CI 1.94-4.35). Time-updated systolic blood pressure showed a U-shaped association with kidney disease progression in IgA nephropathy, with highest risk at SBP ≥140 mmHg (HR 2.91; 95% CI 1.94-4.35) vs 110-119 mmHg.
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