Chronic kidney disease progression in patients with previous type 2 diabetes and/or hypertension: a population-based cohort study from primary care in Spain.

OBJECTIVES

To evaluate whether between hypertension and type 2 diabetes (T2D)-established drivers of chronic kidney disease (CKD) progression-one might be more strongly associated with CKD progression than the other.

DESIGN

Cohort study using a primary care database (electronic health records).

SETTING

Primary care in Catalonia, Spain.

PARTICIPANTS

438 273 patients with CKD identified from the Information System for Research in Primary Care database in Catalonia (2007-2017) and stratified into four mutually exclusive groups based on the presence/absence of hypertension and/or T2D. Distribution of the CKD study cohort was as follows: CKD with hypertension (51.1%), CKD with T2D (3.9%), CKD with hypertension and T2D (32.8%), CKD without hypertension and T2D (12.2%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Patients were followed up to identify the occurrence of severe kidney impairment (SKI) and kidney failure (kidney replacement therapy/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m). Subdistributional hazard ratios (sHRs) were estimated using Cox regression adjusted for confounders.

RESULTS

Compared with the CKD without hypertension and T2D group, adjusted sHRs (95% CIs) for SKI/kidney failure were 1.77 (1.65 to 1.89) for CKD with hypertension and T2D, 1.50 (1.41 to 1.59) for CKD with hypertension and 1.21 (1.09 to 1.34) for CKD with T2D, and for kidney failure were 1.24 (1.10 to 1.39) for CKD with hypertension, 0.74 (0.61 to 0.90) for CKD with T2D and 1.09 (0.96 to 1.24) for CKD with hypertension and T2D. The strongest risk factors for CKD progression were low eGFR and albuminuria, even at mild-moderate levels.

CONCLUSIONS

Hypertension could be associated with an equal/greater risk of CKD progression as T2D. Efforts to slow CKD progression should target both patients with hypertension and T2D, focusing on the identification, close monitoring and effective management of albuminuria and reduced eGFR.