BP and Renal Outcomes in Diabetic Kidney Disease: The Veterans Affairs Nephropathy in Diabetes Trial Journal Article

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Authors: Leehey, D. J.; Zhang, J. H.; Emanuele, N. V.; Whaley-Connell, A.; Palevsky, P. M.; Reilly, R. F.; Guarino, P.; Fried, L. F.; VA NEPHRON-D Study Group
Article Title: BP and Renal Outcomes in Diabetic Kidney Disease: The Veterans Affairs Nephropathy in Diabetes Trial
Abstract: BACKGROUND AND OBJECTIVES: Proteinuric diabetic kidney disease frequently progresses to ESRD. Control of BP delays progression, but the optimal BP to improve outcomes remains unclear. The objective of this analysis was to evaluate the relationship between BP and renal outcomes in proteinuric diabetic kidney disease. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: BP data from all 1448 randomized participants in the Veterans Affairs Nephropathy in Diabetes Trial were included in a post hoc analysis. The associations of mean on-treatment BP with the primary end point (decline in eGFR, ESRD, or death), renal end point (decline in eGFR or ESRD), rate of eGFR decline, and mortality were measured. RESULTS: The median (25th, 75th percentile) follow-up time was 2.2 (1.2, 3.0) years. There were 284 primary end points. In univariate analyses, both mean systolic and mean diastolic BPs were strongly associated (P/= 150 mmHg (P=0.02), with a significantly higher hazard ratio for 140-149 versus 120-129 mmHg (1.51 [1.06, 2.15]; P=0.02). There was also a significant association of mean diastolic BP with the hazard of developing the primary end point (P/= 150 mmHg (P=0.02), with a significantly higher hazard ratio for 140-149 versus 120-129 mmHg (1.51 [1.06, 2.15]; P=0.02). There was also a significant association of mean diastolic BP with the hazard of developing the primary end point (P/= 140 mmHg and mean diastolic BP >/= 80 mmHg were associated with worse renal outcomes.
Journal Title: Clinical journal of the American Society of Nephrology : CJASN
Volume: 10
Issue: 12
ISSN: 1555-905X; 1555-9041
Publisher: by the American Society of Nephrology  
Journal Place: United States
Date Published: 2015
Start Page: 2159
End Page: 2169
Language: eng
DOI/URL:

10.2215/CJN.02850315
Notes: LR: 20160106; CI: Copyright (c) 2015; JID: 101271570; OID: NLM: PMC4670761 [Available on 12/07/16]; OTO: NOTNLM; PMCR: 2016/12/07 00:00; 2015/03/11 [received]; 2015/09/08 [accepted]; 2015/10/19 [aheadofprint]; ppublish