Progression of Renal function and BP control in CKD patients followed in the OPD at Bahrain Specialist Hospital

1. CARDIOVASCULAR RISK FACTORS, BLOOD PRESSURE CONTROL, AND KIDNEY FUNCTION
PROGRESSION AMONG CHRONIC KIDNEY DISEASE POPULATION.
Jafar Al-Said, M.B. CHb. MD. FASN, FACP. Teerath Kumar MBBS. FCPS. Soni Murdeshwar.
Bahrain Specialist Hospital
Introduction:
Patients with HTN and CKD has increased
CV risk factors. CKD OPD population at
Bahrain Specialist Hospital were analyzed.
Aim: study our CKD population regarding:
• CV risk profile.
• HTN prevalence & treatment.
• Kidney function progression.
Methodology:
* Retrospective.
* OPD population with CKD.
* 102 months. Oct. 2003 – April 2012.
Data: Demographic, CV risk & medications.
Estimate eGFR by CKD EPI.
Exclude: Transplant, Pregnant, Primary GN.
Results: * Mean age 58.7 y (SE 0.9).
* Males 61%
Kidney function outcome
Final BP control:
Type of medications used
Number of medication needed to keep BP <140/90
Prevalence of CV Risks among CKD
Relation of the number of CV risk & CKD stage
Cumulative numbers of CV risk factors in CKD
Conclusion: Among our CKD patients:
- HTN is the most Common CV risk factors.
- CV risk factors increase with CKD stage.
- 58% needed combination antiHTN Medications.
- CKD progression was stable over 108 months.
- Final eGFR was correlated with: Gender, DM,
systolic BP, Albumin, Ca blocker, Vasodil. & NTG.
Univariat correlation with eGFR progression
Controlled
43%
57%
5%
11%
18%
24%
17% 18%
6%
1%
0%
10%
20%
30%
1 2 3 4 5 6 7 8
Mean = 4
91%
72%
60%
43%
20% 9% 6%
0%
20%
40%
60%
80%
100%
2.5 2.4
3.1 3.2 3.5
1
2
3
4
I II III IV V
P = 0.001
12%
30%
36%
12% 7%
2% 1%
0%
10%
20%
30%
40%
0 1 2 3 4 5 6
61%
29%
37.70%
14%
41%
3%
10% 14%
0%
15%
30%
45%
60%

2. CARDIOVASCULAR RISK FACTORS, BLOOD PRESSURE CONTROL, AND
KIDNEY FUNCTION PROGRESSION AMONG CKD POPULATION.
Jafar Al-Said, M.B. CHb. MD. FASN, FACP. Teerath Kumar MBBS. FCPS. Soni Murdeshwar
23rd Annual European Society of Hypertension meeting.
Milan. 16. June. 2013

3. Introduction
• Patients with HTN and CKD have increased CV risk
factors.
• Different population have different CV risk profile.
• Determining the CV risk factors will help in planning a
preventive protocol for these patients.
• We wanted to identify the CV risk for our CKD
population at Bahrain Specialist Hospital.

4. Aim
• Determine the CV risk profile among our
CKD population.
• Identify HTN prevalence in that cohort. &
their treatment.
• Determine the progression of CKD
among these patients an their related
factors.

5. Methodology
Retrospective.
• OPD population with CKD.
• 102 months. Oct. 2003 – April 2012.
Data:
Demographic, CV risk & medications.
Estimate eGFR by CKD EPI.
Exclude: Transplant, Pregnant, Primary GN.

6. Results
Total CKD population = 245 .
Total CKD and HTN = 223.
Mean age 58.7 y (SE 0.9).
Males 61%.

7. Cardiovascular risk factors
Total CKD population, n = 245
91%
72%
60%
43%
20%
9%
6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HTN Hyperlipi. DM Hyperuric. IHD PVD Stroke
Type of CV disease

8. Total CV risk including Age, Gender & BMI
5%
11%
18%
24%
17% 18%
6%
1%
0%
5%
10%
15%
20%
25%
30%
1 2 3 4 5 6 7 8
Mean = 4
Cumulative number of CV risks

9. Mean number of CV risk factors according to CKD stage.
Other than CKD.
2.5
2.4
3.1
3.2
3.5
1
1.5
2
2.5
3
3.5
4
I II III IV V
P = 0.001
MeanNumberofCV
CKD staging

10. Blood Pressure Control < 140/90mmHg
43%
57%Controlled
Uncontrolled

11. Number of Anti HTN medications needed to
control BP <140/90mmHg in CKD & HTN
12%
30%
36%
12%
7%
2% 1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
0 1 2 3 4 5 6
Number of Anti HTN Medications

12. 61%
29%
37.70%
14%
41%
3%
10%
14%
0%
10%
20%
30%
40%
50%
60%
70%
Antihypertensive drugs used in the HTN group

13. `Progression of kidney function among
HTN CKD population

14. Variables Correlation Coefficient P
Gender -0.29 <0.0001
DM -0.19 0.006
First Systolic -0.15 0.03
First Hb 0.44 <0.0001
First Albumin 0.27 0.003
Final Albumin 0.21 0.04
Ca Channel -0.16 0.023
Vasodilator -0.23 0.001
NTG -0.21 0.002
Independent Univariate Correlated
Variables with final eGFR.

15. Final Conclusion
• CKD patient carry high CV risk factors.
• HTN is the most common CV risk factor among
CKD population.
• 57 % of the HTN CKD were controlled after 2
years of follow up.
• 58% of the CKD and HTN patient needed >
AntiHTN medication to control BP.
• Kidney function was stable over 2 years.