Key result
Optimal CKD risk prediction in hypertension requires combining established renal markers with ambulatory BP and biomarkers.
Why the study?
Accurate identification of patients with arterial hypertension at risk of chronic kidney disease progression is essential for optimizing management and timing of interventions, but conventional markers reflect limited disease components.
This narrative review emphasizes the need to integrate novel biomarkers, ambulatory blood pressure monitoring, and longitudinal marker trajectories with traditional markers to better predict chronic kidney disease progression in hypertensive patients.
Chronic kidney disease and arterial hypertension form a bidirectional pathophysiological continuum in which elevated blood pressure accelerates nephron injury, while declining kidney function promotes sodium retention, neurohormonal activation, vascular dysfunction, and treatment-resistant hypertension. The clinical course is heterogeneous: some patients maintain stable kidney function for years, whereas others experience rapid estimated glomerular filtration rate decline, increasing albuminuria, recurrent acute kidney injury, cardiovascular complications, and progression to kidney failure. Accurate identification of the latter group is essential for selecting monitoring intensity, optimizing antihypertensive and kidney-protective therapy, and determining the timing of nephrology referral and preparation for kidney replacement therapy. Conventional markers—including office and ambulatory blood pressure, serum creatinine, estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, urinary sediment findings, serum potassium, bicarbonate, hemoglobin, and mineral metabolism parameters—remain central to routine assessment. However, each marker reflects only a limited component of the underlying disease process. Creatinine-based filtration estimates may be influenced by muscle mass and nutritional status, albuminuria may fluctuate substantially, and office blood pressure may fail to identify masked, nocturnal, or episodic hypertension. Consequently, increasing attention has been directed toward longitudinal marker trajectories, cystatin C, tubular injury molecules, inflammatory mediators, endothelial dysfunction markers, cardiac biomarkers, proteomic and metabolomic signatures, and multivariable kidney failure prediction models. This narrative review examines the mechanisms linking arterial hypertension with chronic kidney disease progression and evaluates the clinical and laboratory markers available for risk stratification. Particular attention is given to the complementary prognostic roles of estimated glomerular filtration rate slope, albuminuria, ambulatory blood pressure patterns, blood pressure variability, tubular and inflammatory biomarkers, and integrated risk equations. https://doi.org/10.52783/jchr.v16.i4.15782
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Zhuk Inessa (2026) conducted a review in Chronic kidney disease and arterial hypertension. Clinical and laboratory markers of CKD progression was evaluated. Accurate risk stratification for CKD progression in hypertensive patients requires integrating established markers like eGFR trajectories and albuminuria with complementary data such as ambulatory blood pressure and emerging biomarkers.
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