Antihypertensive Treatment Patterns in CKD Stage 3 and 4: The CKD-REIN Cohort Study
2024
Costes-Albrespic, Margaux | Liabeuf, Sophie | Laville, Solène | Jacquelinet, Christian | Combe, Christian | Fouque, Denis | Laville, Maurice | Frimat, Luc | Pecoits-Filho, Roberto | Lambert, Oriane | Massy, Ziad | Sautenet, Bénédicte | Alencar de Pinho, Natalia | Alencar de Pinho, Natalia | Combe, Christian | Fouque, Denis | Frimat, Luc | Hamroun, Aghilès | Jacquelinet, Christian | Laville, Maurice | Omorou, Abdou | Pascal, Christophe | Pecoits-Filho, Roberto | Stengel, Bénédicte | Lange, Céline | Lambert, Oriane | Metzger, Marie | Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay | Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires - UR UPJV 7517 (MP3CV) ; Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie | CHU Amiens-Picardie | Agence de la biomédecine [Saint-Denis la Plaine] | Sexualité et soins (Genre, Sexualité, Santé) (CESP - INSERM U1018 - Equipe 7) ; Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay | Service de Néphrologie-transplantation-dialyse [Bordeaux] ; Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux) | Bioingénierie tissulaire (BIOTIS) ; Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN) ; Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS) ; Hospices Civils de Lyon (HCL) | Association pour l'Utilisation du Rein Artificiel Région Lyonnaise (AURAL) | Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy) | Pontifícia Universidade Católica do Paraná [Curitiba, Brasil] = Pontifical Catholic University of Paraná [Curitiba, Brazil] = Université catholique pontificale du Paraná [Curitiba, Brésil] (PUCPR) | Arbor Research Collaborative for Health | Service Néphrologie/Dialyse [AP-HP Ambroise-Paré] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP] | Centre Hospitalier Régional Universitaire [CHU Lille] (CHRU Lille) | Bordeaux population health (BPH) ; Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Service d'Epidémiologie et de Santé Publique [Lille] ; Centre Hospitalier Régional Universitaire [CHU Lille] (CHRU Lille)
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Mostrar más [+] Menos [-]Inglés. Rationale & ObjectiveBlood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP (SBP).Study DesignProspective observational cohort studySetting & Population2755 hypertensive patients with CKD stages 3–4, receiving care from a nephrologist, from the French CKD-REIN cohort studyExposurePatient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary-care physician and specialist encounters.OutcomesChanges in antihypertensive drug class prescription during follow-up: add-on, or withdrawal.Analytical ApproachHierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level, and linear mixed models to describe Systolic BP trajectory.ResultsAt baseline, median age was 69, mean eGFR, 33 ml/min/1.73m2; 66% of patients were men, 81% had BP ≥130/80 mmHg and 75% were prescribed ≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons and 25 per 100 for withdrawals. After adjusting for risk factors, Systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on, 1.35 (95% confidence interval, 1.01-1.80), while a shorter education level was associated with increased HR for withdrawal, 1.23 (1.02-1.49) for 9-11 years versus ≥12 years. More frequent nephrologist visits (≥4 versus none) were associated with higher HRs of add-on and withdrawal (1.52; 95% CI 1.06-2.18 and 1.57; 1.12-2.19, respectively), while associations with visit frequency to other physicians varied with their specialty. Mean Systolic BPdecreased by 4 mmHg following drug add-on but tended to rise thereafter.LimitationsLack of information on prescriber, and drug dosing.Conclusions: In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in Systolic BPafter add-on of a drug class is infrequently achieved.
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Este registro bibliográfico ha sido proporcionado por Institut national de la recherche agronomique