Association of Blood Pressure With the Progression of CKD: Findings From KNOW-CKD Study

Abstract Rationale & Objective Optimal blood pressure (BP) control is a major therapeutic strategy in the management of chronic kidney disease (CKD). We studied the association of BP with adverse kidney outcomes within a diverse cohort of Koreans with CKD. Study Design Prospective observational cohort study. Setting & Participants 2,044 participants from the KoreaN Cohort Study for Outcomes in patients With CKD (KNOW-CKD). Exposures Baseline and time-updated systolic BP (SBP) and diastolic BP (DBP). Outcome A composite kidney outcome of a ≥50% decline in estimated glomerular filtration rate (eGFR) from the baseline value or the onset of end-stage kidney disease. Analytical Approach Multivariable cause-specific hazards models and marginal structural models were fit for baseline and time-updated BP, respectively. Results During 7,472 person-years of follow-up, the primary composite outcome occurred in 473 (23.1%) participants (incidence rate, 63.3 per 1,000 patient-years). Compared with baseline SBP Limitations Observational design, unmeasured confounders, and use of only office BPs. Conclusions In patients with CKD, higher SBP and DBP levels were associated with a higher risk of CKD progression. SBP had a greater association with adverse kidney outcomes than DBP.