Document Detail


Kidney function can improve in patients with hypertensive CKD.
MedLine Citation:
PMID:  22402803     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The typical assumption is that patients with CKD will have progressive nephropathy. Methodological issues, such as measurement error and regression to the mean, have made it difficult to document whether kidney function might improve in some patients. Here, we used data from 12 years of follow-up in the African American Study of Kidney Disease and Hypertension to determine whether some patients with CKD can experience a sustained improvement in GFR. We calculated estimated GFR (eGFR) based on serum creatinine measurements during both the trial and cohort phases. We defined clearly improved patients as those with positive eGFR slopes that we could not explain by random measurement variation under Bayesian mixed-effects models. Of 949 patients with at least three follow-up eGFR measurements, 31 (3.3%) demonstrated clearly positive eGFR slopes. The mean slope among these patients was +1.06 (0.12) ml/min per 1.73 m(2) per yr, compared with -2.45 (0.07) ml/min per 1.73 m(2) per yr among the remaining patients. During the trial phase, 24 (77%) of these 31 patients also had clearly positive slopes of (125)I-iothalamate-measured GFR during the trial phase. Low levels of proteinuria at baseline and randomization to the lower BP goal (mean arterial pressure ≤92 mmHg) associated with improved eGFR. In conclusion, the extended follow-up from this study provides strong evidence that kidney function can improve in some patients with hypertensive CKD.
Authors:
Bo Hu; Crystal Gadegbeku; Michael S Lipkowitz; Stephen Rostand; Julia Lewis; Jackson T Wright; Lawrence J Appel; Tom Greene; Jennifer Gassman; Brad C Astor;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-03-08
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  23     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  2012-05-21     Revised Date:  2014-04-17    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  706-13     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
African Americans / statistics & numerical data
Aged
Antihypertensive Agents / therapeutic use
Bayes Theorem
Creatinine / blood*
Female
Follow-Up Studies
Glomerular Filtration Rate / physiology*
Humans
Hypertension, Renal / diagnosis*,  drug therapy,  ethnology
Kidney Failure, Chronic / diagnosis*,  ethnology
Kidney Function Tests
Male
Middle Aged
Reference Values
Risk Assessment
Severity of Illness Index
Time Factors
Young Adult
Grant Support
ID/Acronym/Agency:
2P20RR11104/RR/NCRR NIH HHS; 5M01 RR-00071/RR/NCRR NIH HHS; DK2818-02/DK/NIDDK NIH HHS; M01 RR-00080/RR/NCRR NIH HHS; M01 RR00827/RR/NCRR NIH HHS; M0100032//PHS HHS; M01RR00052/RR/NCRR NIH HHS; P20-RR11145/RR/NCRR NIH HHS; R01 DK090046/DK/NIDDK NIH HHS; R01 DK090046-01/DK/NIDDK NIH HHS; U01 DK048652/DK/NIDDK NIH HHS; UL1 RR024989/RR/NCRR NIH HHS; UL1 RR024989/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; AYI8EX34EU/Creatinine
Comments/Corrections
Comment In:
J Am Soc Nephrol. 2012 Apr;23(4):575-7   [PMID:  22402801 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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