BP in Young Adults with CKD and Associations with Cardiovascular Events and Decline in Kidney Function

Significance Statement Although young adults (aged 18–40 years) with CKD are at risk for poor cardiovascular and renal outcomes, with hypertension an important and potentially modifiable risk factor, they are largely absent from observational studies and clinical trials of BP in patients with CKD. To address this knowledge gap, this observational study provides a description of BP and its relation to outcomes specifically in young adults with CKD. It demonstrates that among young adults with CKD, higher BP is associated with cardiovascular events (particularly heart failure) and CKD progression. The study’s findings may provide a foundation for future work to develop best practices for BP management in young adults with CKD and improve outcomes. Background BP is an important modifiable risk factor for cardiovascular events and CKD progression in middle-aged or older adults with CKD. However, studies describing the relationship between BP with outcomes in young adults with CKD are limited. Methods In an observational study, we focused on 317 young adults (aged 21–40 years) with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Exposures included baseline systolic BP evaluated continuously (per 10 mm Hg increase) and in categories (<120, 120–129, and ≥130 mm Hg). Primary outcomes included cardiovascular events (heart failure, myocardial infarction, stroke, or all-cause death) and CKD progression (50% decline of eGFR or ESKD). We used Cox proportional hazard models to test associations between baseline systolic BP with cardiovascular events and CKD progression. Results Cardiovascular events occurred in 52 participants and 161 had CKD progression during median follow-up times of 11.3 years and 4.1 years, respectively. Among those with baseline systolic BP ≥130 mm Hg, 3%/yr developed heart failure, 20%/yr had CKD progression, and 2%/yr died. In fully adjusted models, baseline systolic BP ≥130 mm Hg (versus systolic BP<120 mm Hg) was significantly associated with cardiovascular events or death (hazard ratio [HR], 2.13; 95% confidence interval [95% CI], 1.05 to 4.32) and CKD progression (HR, 1.68; 95% CI, 1.10 to 2.58). Conclusions Among young adults with CKD, higher systolic BP is significantly associated with a greater risk of cardiovascular events and CKD progression. Trials of BP management are needed to test targets and treatment strategies specifically in young adults with CKD.