Blog entry by Meguid El Nahas

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BLOG PROF ARIF KHWAJA (GLOBAL KIDNEY ACADEMY)
 
Clin J Am Soc Nephrol. 2015 Apr 21. pii: CJN.07370714. [Epub ahead of print]

Rate of Change in Renal Function and Mortality in Elderly Treated Hypertensive Patients.

 

Abstract

BACKGROUND AND OBJECTIVES:

Evidence relating the rate of change in renal function, measured as eGFR, after antihypertensive treatment in elderly patients to clinical outcome is sparse. This study characterized the rate of change in eGFR after commencement of antihypertensive treatment in an elderly population, the factors associated with eGFR rate change, and the rate's association with all-cause and cardiovascular mortality.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Data from the Second Australian National Blood Pressure study were used, where 6083 hypertensive participants aged ≥65 years were enrolled during 1995-1997 and followed for a median of 4.1 years (in-trial). Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). The annual rate of change in the eGFR was calculated in 4940 participants using creatinine measurements during the in-trial period and classified into quintiles (Q) on the basis of the following eGFR changes: rapid decline (Q1), decline (Q2), stable (Q3), increase (Q4), and rapid increase (Q5).

RESULTS:

A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. However, a rapid increase in eGFR was observed in younger women and those with a higher cholesterol level. After adjustment for baseline and in-trial covariates, Cox-proportional hazard models showed a significantly greater risk for both all-cause (hazard ratio, 1.28; 95% confidence interval, 1.09 to 1.52; P=0.003) and cardiovascular (hazard ratio, 1.40; 95% confidence interval, 1.11 to 1.76; P=0.004) mortality in the rapid decline group compared with the stable group over a median of 7.2 years after the last eGFR measure. No significant association with mortality was observed for a rapid increase in eGFR.

CONCLUSIONS:

In elderly persons with treated hypertension, a rapid decline in eGFR is associated with a higher risk of mortality.

COMMENTARY:

There is something wrong with the world of publications and journals... So elderly patients with rapidly declining eGFR are more likely to die?!

And cjASN has a reasonable impact factor... !!!!!

We are drowning in information ... Most of it associative, a lot of it a rehash of previous work... And it means we can't see the wood from the trees ... The value of a publication now is primarily for the author rather than the wider readership...its like satellite TV ... Hundreds of channels but hardly anything worth watching!!!

[ Modified: Thursday, 1 January 1970, 1:00 AM ]

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