| Hypertension is a cardiovascular syndrome characterized by increased arterial pressure,which can damage the structure and function of the heart,brain,kidney and other organs.The structure and function of the kidney will be damaged by ineffectively controlled hypertension,resulting in chronic kidney disease.Hypertension is the second leading cause of end-stage renal disease worldwide,second only to diabetes.In China,the prevalence of hypertension and chronic kidney disease caused by hypertension is increasing year by year.It is very important to screen the high-risk population of chronic kidney disease complicated with hypertension and intervene it in time to prevent it from developing into end-stage renal disease.Objectives and significance:1.To analyze the risk factors of chronic kidney disease in patients with hypertension.2.By estimating the population attributable risks of each risk factor,this study aimed to find out the most valuable intervention.targets.3.To form a novel prediction model by analyzing high-risk populations of chronic kidney disease induced by hypertension.Methods:Participants:5709 patients with hypertension and without CKD who participated in the annual community physical examination in Xintang Hospital,Zengcheng District,Guangzhou from 2015 to 2020.Endpoint:incident CKD which was defined as eGFR<60 ml/(min·1.73m2)during the follow-up period,excluding acute renal injury.Statistical analysis:Continuous variables are described as the mean±SD or median and IQR,and compared through t-test or nonparametric test.Categorical variables are reported as absolute values and percentages and compared through the Chi-square test or Fisher’s exact test.Univariable Cox analysis included variables that were imbalanced between patients with or without incident CKD.For better clinical implication,compared with the continuous variables,the categorical variables were more likely to be included in to the univariable analysis.Variables with p values<0.05 in the univariable analysis were entered into multivariable Cox regression analysis,and a backward stepwise approach which successively removing non-significant covariates(P>0.05)until all the remaining predictors are statistically significant was then taken to identify the independent risk factors.PAR was calculated based on the prevalence of each risk factor in our database.Results:Finally,5709 patients were included in the analysis,of which 1089(19.06%)became CKD.Among the independent risk factors of CKD,hyperuricemia,anemia,baseline systolic blood pressure≥180mmHg and baseline diastolic blood pressure≥110mmHg were modifiable.Among the four modifiable risk factors,hyperuricemia had the highest prevalence(33.25%),and baseline diastolic blood pressure≥110mmHg had the lowest prevalence(1.31%).Hyperuricemia had the highest PAR(5.94%,95%CI 0.99-10.69),followed by anemia(5.17%,95%CI 2.23-8.57)and systolic blood pressure≥180mmHg(3.40%,95%CI 0.83-6.43).Baseline diastolic blood pressure≥110mmHg had the lowest PAR(1.01%,95%CI 0.12-2.45).The simple nomogram including five predictors of incident CKD(age,BMI,hemoglobin,history of diabetes and baseline eGFR level)was established and demonstrated a good predictive power with a C-index of 0.793(95%CI:0.786-0.802).Area under curve were 0.834,0.839 and 0.858 in 3-year,4-year and 5-year prediction.The calibration curve also showed a good calibration.Conclusion:1.In hypertensive population,advanced age,high baseline serum creatinine and history of diabetes may be risk factors for CKD.Higher hemoglobin level and daily exercise may play a role in protecting renal function.2.In hypertensive population,intervention of hyperuricemia and anemia,and good blood pressure control may be an effective strategy to reduce the risk of incident CKD.3.This study established an incident CKD prediction model based on age,BMI,hemoglobin,diabetes history and baseline eGFR level,which can effectively estimate the risk. |
