Amanda H. Anderson, PhD, MPH; Wei Yang, PhD; Raymond R. Townsend, MD; Qiang Pan, MA; Glenn M. Chertow, MD, MPH; John W. Kusek, PhD; Jeanne Charleston, BSN, RN; Jiang He, MD, PhD; RadhaKrishna Kallem, MD, MPH; James P. Lash, MD; Edgar R. Miller, III, MD, PhD; Mahboob Rahman, MD, MS; Susan Steigerwalt, MD; Matthew Weir, MD; Jackson T. Wright, Jr., MD, PhD; Harold I. Feldman, MD, MSCE; for the Chronic Renal Insufficiency Cohort Study Investigators (*)
Presented in part at Kidney Week 2012, American Society of Nephrology, San Diego, California, on 30 October to 4 November 2012.
Disclaimer: Dr. Anderson had full access to all study data and takes responsibility for this article. The views expressed in this article do not necessarily reflect those of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.
Acknowledgment: The authors thank the CRIC Study patients, study coordinators, and investigators for their efforts, as well as Valerie Teal, MS, for analytic support.
Grant Support: By the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (cooperative agreements U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01D K060980, U01DK060963, and U01DK060902) and in part by the following institutional Clinical Translational Science Awards from the National Center for Advancing Translational Sciences and other National Institutes of Health grants: University of Pennsylvania (UL1TR000003, K01DK092353, and K24DK002651), Johns Hopkins University (UL1 TR-000424), University of Maryland General Clinical Research Center (M01 RR-16500), Clinical and Translational Science Collaborative of Cleveland (UL1TR000439), Michigan Institute for Clinical and Health Research (UL1TR000433), University of Illinois at Chicago (UL1RR029879), Tulane University Translational Research in Hypertension and Renal Biology (P30GM103337), and Kaiser Permanente National Institutes of Health/National Center for Research Resources University of California, San Francisco Clinical and Translational Science Institute (UL1 RR-024131).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0488.
Reproducible Research Statement:Study protocol: Available at www.niddkrepository.org/studies/cric/cric%20protocols. Statistical code: Available from Dr. Anderson (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Amanda H. Anderson, PhD, MPH, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, 819 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail, email@example.com.
Current Author Addresses: Drs. Anderson, Yang, and Feldman and Mr. Pan: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, 819 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Dr. Townsend: Renal/Hypertension Division, University of Pennsylvania Perelman School of Medicine, 122 Founders Building, Philadelphia, PA 19104.
Dr. Chertow: Stanford University School of Medicine, 777 Welch Road, Suite DE, Room D100, Palo Alto, CA 94304.
Dr. Kusek: Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 2 Democracy Boulevard, Bethesda, MD 20892.
Ms. Charleston: Johns Hopkins University ProHealth, 1849 Gwynn Oak Avenue, Suite 1, Baltimore, MD 21207.
Dr. He: Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA 70112.
Dr. Kallem: Renal/Hypertension Division, University of Pennsylvania Perelman School of Medicine, Smilow Center for Translational Research, G-229, Building 421, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
Dr. Lash: Section of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, Medical Center 793, Chicago, IL 60612.
Dr. Miller: The Johns Hopkins Medical Institution, 2024 East Monument Street, Suite 2-624, Baltimore, MD 21205.
Drs. Rahman and Wright: Division of Hypertension and Nephrology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Bolwell Health Clinic, Suite 2200, Cleveland, OH 44106.
Dr. Steigerwalt: Renaissance Renal Research Institute, 22201 Moross, Suite 150, Detroit, MI 48336.
Dr. Weir: University of Maryland Medical Center, N3W143 Nephrology, 22 South Greene Street, Baltimore, MD 21201.
Author Contributions: Conception and design: A.H. Anderson, R.R. Townsend, J. He, R. Kallem, M. Rahman, M. Weir, J.T. Wright, H.I. Feldman.
Analysis and interpretation of the data: A.H. Anderson, W. Yang, R.R. Townsend, Q. Pan, G.M. Chertow, J.W. Kusek, J. He, R. Kallem, J.P. Lash, M. Rahman, M. Weir, J.T. Wright, H.I. Feldman.
Drafting of the article: A.H. Anderson, R.R. Townsend, R. Kallem, J.P. Lash, J.T. Wright, H.I. Feldman.
Critical revision of the article for important intellectual content: A.H. Anderson, R.R. Townsend, G.M. Chertow, J.W. Kusek, J. He, R. Kallem, J.P. Lash, E.R. Miller, M. Rahman, S. Steigerwalt, M. Weir, J.T. Wright, H.I. Feldman.
Final approval of the article: A.H. Anderson, R.R. Townsend, G.M. Chertow, J.W. Kusek, J. Charleston, J. He, R. Kallem, J.P. Lash, E.R. Miller, M. Rahman, S. Steigerwalt, J.T. Wright, H.I. Feldman.
Provision of study materials or patients: J. He, R. Kallem, E.R. Miller, M. Rahman, S. Steigerwalt, J.T. Wright.
Statistical expertise: A.H. Anderson, W. Yang, R. Kallem, H.I. Feldman.
Obtaining of funding: A.H. Anderson, R.R. Townsend, G.M. Chertow, J.W. Kusek, J.P. Lash, M. Rahman, J.T. Wright, H.I. Feldman.
Administrative, technical, or logistic support: J.W. Kusek, R. Kallem, J.T. Wright, H.I. Feldman.
Collection and assembly of data: A.H. Anderson, R.R. Townsend, J. Charleston, J. He, R. Kallem, J.P. Lash, E.R. Miller, M. Rahman, S. Steigerwalt, J.T. Wright, H.I. Feldman.
Previous reports of the longitudinal association between achieved blood pressure (BP) and end-stage renal disease (ESRD) among patients with chronic kidney disease (CKD) have not incorporated time-updated BP with appropriate covariate adjustment.
To assess the association between baseline and time-updated systolic blood pressure (SBP) with CKD progression.
Observational, prospective cohort study. (ClinicalTrials.gov: NCT00304148)
7 U.S. clinical centers.
Patients in the Chronic Renal Insufficiency Cohort Study (n = 3708) followed for a median of 5.7 years (25th to 75th percentile, 4.6 to 6.7 years).
The mean of 3 seated SBP measurements made up the visit-specific SBP. Time-updated SBP was the mean of that and all previous visits. Outcomes were ESRD and the composite end point of ESRD or halving of the estimated glomerular filtration rate. Analyses investigating baseline and time-updated SBP used Cox proportional hazards models and marginal structural models, respectively.
Systolic blood pressure was 130 mm Hg or greater at all visits in 19.2% of patients. The hazard ratio for ESRD among patients with SBP of 130 to 139 mm Hg, compared with SBP less than 120 mm Hg, was 1.46 (95% CI, 1.13 to 1.88) using only baseline data and 2.37 (CI, 1.48 to 3.80) using time-updated data. Among patients with SBP of 140 mm Hg or greater, corresponding hazard ratios were 1.46 (CI, 1.18 to 1.88) and 3.37 (CI, 2.26 to 5.03) for models using only baseline data and those using time-updated data, respectively.
Blood pressure was measured once annually, and the cohort was not a random sample.
Time-updated SBP greater than 130 mm Hg was more strongly associated with CKD progression than analyses based on baseline SBP.
National Institute of Diabetes and Digestive and Kidney Diseases.
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Anderson AH, Yang W, Townsend RR, Pan Q, Chertow GM, Kusek JW, et al. Time-Updated Systolic Blood Pressure and the Progression of Chronic Kidney Disease: A Cohort Study. Ann Intern Med. 2015;162:258-265. doi: 10.7326/M14-0488
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Published: Ann Intern Med. 2015;162(4):258-265.
Chronic Kidney Disease, Diabetic Nephropathy, Nephrology.
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