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A Population-Based, Prospective Study of Blood Pressure and Risk for End-Stage Renal Disease in China

Kristi Reynolds^*, Dongfeng Gu, Paul Muntner^*,, John W. Kusek, Jing Chen, Xigui Wu, Xiufang Duan, Chung-Shiuan Chen^*, Michael J. Klag^||, Paul K. Whelton^*, and Jiang He^*,

^* Department of Epidemiology, School of Public Health and Tropical Medicine; Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana; Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, and Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; and ^|| Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Address correspondence to: Dr. Kristi Reynolds, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2036, New Orleans, LA 70112. Phone: 504-988-6972; Fax: 504-988-7448; kristi.reynolds{at}tulane.edu

Received for publication November 3, 2006. Accepted for publication March 19, 2007.

The association between BP and risk for ESRD has not been well characterized in Asian populations. This study examined the relationship between level of BP and incidence of ESRD in a prospective cohort study of 158,365 Chinese men and women who were 40 yr and older. Measurement of BP and covariables were made in 1991 following a standard protocol. Follow-up evaluations were conducted in 1999 to 2000 and included interviewing participants or proxies and obtaining medical records and death certificates for ESRD cases. During 1,236,422 person-years of follow-up, 380 participants initiated renal replacement therapy or died from renal failure (30.7 cases per 100,000 person-years). Compared with those with normal BP, the multivariate adjusted hazard ratios (95% confidence interval) of all-cause ESRD for prehypertension and stage 1 and stage 2 hypertension were 1.30 (0.98 to 1.74), 1.47 (1.06 to 2.06), and 2.60 (1.89 to 3.57), respectively (P < 0.001 for trend). The corresponding hazard ratios (95% confidence interval) of glomerulonephritis-related ESRD were 1.32 (0.82 to 2.11), 1.48 (0.83 to 2.61), and 3.40 (2.02 to 5.74), respectively (P <0.001 for trend). Systolic BP was a stronger predictor of ESRD than diastolic BP or pulse pressure. This study provides novel data on the incidence of ESRD and on the association between BP and glomerulonephritis-related ESRD from a nationally representative sample of adults in China. These results document the importance of high BP as a modifiable risk factor for ESRD in China. Strategies to prevent ESRD should incorporate the prevention, treatment, and control of BP.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673