대한신장학회

논문분류	춘계학술대회 초록집
제목	Association of Blood Pressure with Mortality and Adverse Cardiovascular Outcome in Chronic Kidney Disease: The Results from KNOW-CKD Study
저자	Jee Young Lee, Shinchan Kang, Hyung Woo Kim, Yooju Nam, Geun Woo Ryu, Seonyeong Lee, Jung Tak Park, Tae-Hyun Yoo, Shin-Wook Kang, Seung Hyeok Han
출판정보	2020; 2020(1):
키워드	CKD \| SBP \| DBP \| All-cause deaths \| cardiovascular outcomes
초록	Optimal BP control is a major therapeutic strategy to reduce cardiovascular events and mortality in the management of CKD. Here, we comprehensively studied the association of BP with all-cause death and adverse cardiovascular outcome in patients with CKD. Among 2,238 participants from the KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD), 2,226 patients with baseline BP measurements were enrolled. The main exposures of interest were baseline and time-updated systolic BP (SBP) categorized by 10 mmHg; <120, 120-129, 130-139, and ≥140 mmHg. We also categorized diastolic BP (DBP) by 10 mmHg; <70, 70-79, 80-89, and ≥90 mmHg. The primary endpoint was all-cause deaths and cardiovascular outcome. The secondary endpoint was all-cause deaths and cardiovascular outcomes, separately. We used cause-specific hazard models for baseline BPs and time-varying Cox models for time-updated BPs. During median follow-up of 8007.3789 person-years, the primary composite outcome occurred in 190 (8.54%) participants with the corresponding incidence rate of 23.7 [95% confidence interval [CI], 20.6-27.4] per 1,000 patient-years. Multivariable-adjusted cause-specific model with baseline SBP did not show significant relationship with primary outcome. However, time-varying model showed graded association of time-updated SBP with risk of primary outcome. Compared with SBP <120 mmHg, the HRs (95% CI) for 120-129, 130-139, and ≥140 mmHg were 1.08 (0.51-2.30), 1.97 (0.05-1.00), and 2.07 (1.02-4.20), respectively. In time-varying model with SBP as a continuous measure, a 10 mmHg increase in time-updated SBP was associated with 15% higher risk of primary outcome. Time-updated DBP was also associated with increased risk of primary outcome. In secondary analyses, there was a graded association of time-updated SBP with risk of all-cause mortality. However, this association was not seen in the analysis for cardiovascular outcome. Korean patients with CKD, higher SBP and DBP were associated with higher risk of composite outcome of all-cause mortality or cardiovascular outcome.
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