Kidney Week

Abstract: SA-PO0508

Association of Baseline Blood Pressure with Adverse Outcomes in Persons with CKD in the NURTuRE-CKD Study

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Lucas, Bethany J., Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom

Bethany J. Lucas, MBChB

• Cockwell, Paul, Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom

Paul Cockwell, MBChB, PhD

• Fraser, Simon DS, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

Simon DS Fraser, MD

• Kalra, Philip A., Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom

Philip A. Kalra, MD, MBChB

• Wheeler, David C., Department of Renal Medicine, University College London, London, United Kingdom

David C. Wheeler, MD

• Taal, Maarten W., Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom

Maarten W. Taal, MD, MBChB

Background

Blood pressure (BP) control is an essential therapeutic target in chronic kidney disease (CKD) but optimal BP targets are still debated. We examined the association between baseline systolic BP, attainment of current guideline targets and adverse outcomes in a large UK prospective cohort study.

Methods

The National Unified Renal Translational Research Enterprise (NURTuRE)-CKD is UK, prospective multi-centre cohort study of adults with CKD G3-G4 or CKD G1-2 with albuminuria >30 mg/mmol. Primary endpoints were kidney failure (KF) and/or the initiation of kidney replacement and all-cause mortality Secondary endpoints were eGFR slope and a combined kidney endpoint (CKE). Cox proportional hazards models examined associations between baseline systolic BP and outcomes and adjusted for age, sex, eGFR and albuminuria. Linear regression was used to examine associations between baseline systolic BP and eGFR slope adjusted for age, sex, and uACR.

Results

2,884 participants were included. Median (IQR) eGFR was 35 (25 to 47)ml/min/1.73m² and uACR 22.3 (3.6 to 101.3) mg/mmol. Median (IQR) systolic and diastolic BP were 137 (125 to 151) mmHg and 80mmHg and (72 to 88) mmHg respectively.
In adjusted Cox models baseline systolic BP was not independently associated with KF or all-cause mortality but it was associated with the CKE (Table 1). Baseline systolic BP was independently associated with a steeper GFR decline: -0.86 (-0.2 to -0.08) mL/min/1.73 m²/year per 10mmHg change in systolic BP.
At baseline 680 (24%) participants had BP <130/80mmHg and 457 (16%) participants had systolic BP <120mmHg. In Kaplan-Meier analyses participants meeting baseline BP targets had significantly fewer events (log rank p<0.001).

Conclusion

In the NURTuRE CKD cohort, systolic baseline BP was not independently associated with increased risk of death or kidney failure but was significantly associated with a steeper eGFR slope and an increased risk of CKE . Attainment of guideline BP targets at baseline was associated with better unadjusted outcomes.

Table 1. Survival analysis for adverse outcomes by baseline systolic blood pressure per 10mmHg

*adjusted for baseline sex, age, eGFR and uACR.