Kidney Week

Abstract: TH-PO1097

Prevalence and Clinical Outcome of Apparent Treatment Resistant Hypertension in CKD in Korea: Korean Cohort Study for Outcome in Patients with CKD (KNOW-CKD)

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kim, Young jin, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Young jin Kim,

• Choi, Hong sang, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Hong sang Choi,

• Kim, Chang Seong, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Chang Seong Kim,

• Bae, Eun Hui, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Eun Hui Bae,

• Ma, Seong Kwon, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Seong Kwon Ma,

• Oh, Kook-Hwan, Department of Internal Medicine, Seoul National University, Seoul, Korea (the Republic of)

Kook-Hwan Oh,

• Ahn, Curie, Department of Internal Medicine, Seoul National University, Seoul, Korea (the Republic of)

Curie Ahn,

• Kim, Soo Wan, Chonnam National University Medical School, Gwangju, Korea (the Republic of)

Soo Wan Kim,

Background

It is not well defined the prevalence and clinical outcome of apparent treatment resistant hypertension(ATRH) in Korean CKD patients. The present study was aimed to investigate the prevalence of ATRH, and its effects on the renal and cardiovascular outcomes and all-cause mortality.

Methods

We collected data of 1878 patients with hypertension in the Korean Cohort Study For Outcome in Patients with Chronic Kidney Disease(KNOW-CKD) to understand ATRH. The definition of ATRH is; 1) systolic blood pressure(BP)≥140mmHg or diastolic BP≥90mmHg with 3 classes of antihypertensive agents, 2) any BP with 4 antihypertensives, at baseline.

Results

374(19.9%) patients revealed ATRH. Presence of ATRH was associated with baseline renal function, sex, diabetes, severity of proteinuria, BMI, and prior history of myocardial infarction. Patients with ATRH showed higher risk of adverse renal outcome than non-ATRH patients. The adjusted renal event hazard ratio(HR) was 1.362[95% CI 1.079-1.719], p=0.0093. Cardiovascular outcome and all-cause mortality were not statistically different (0.884[0.528-1.481], 1.731[0.898-3.338]). The risk of renal events increases with lower baseline renal function. Patients with eGFR<30 ml/min/1.73m2 and eGFR 30~60 showed higher HR than patients with eGFR≥ 60(24.547[12.082-49.875], 4.278[2.072-8.833]). In subgroup analysis, patients used loop diuretics at baseline had higher HR (1.361[1.076-1.720]). Patients who didn’t achieved BP goal(140/90mmHg) with 4 antihypertensives showed higher risk of renal event risk(2.189[1.469-3.269]).

Conclusion

Our study shows that ATRH is associated with high risk of adverse renal outcome in patient with chronic kidney disease. Especially patients with ATRH and CKD stage III~V need more careful approach and management to prevent worsening of renal function.