A Meta-Analysis on Prehypertension and Chronic Kidney Disease

Yang Li; Peng Xia; Lubin Xu; Yang Wang; Limeng Chen

doi:10.1371/journal.pone.0156575

A Meta-Analysis on Prehypertension and Chronic Kidney Disease

PLoS One. 2016 Jun 1;11(6):e0156575. doi: 10.1371/journal.pone.0156575. eCollection 2016.

Authors

Yang Li¹, Peng Xia¹, Lubin Xu¹, Yang Wang², Limeng Chen¹

Affiliations

¹ Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Biological Information and Statistics Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Recent studies have demonstrated that there is an association between prehypertension and an increased risk of end-stage renal disease. However, there is conflicting evidence regarding the relationship between prehypertension and chronic kidney disease (CKD). This meta-analysis aimed to demonstrate the association between prehypertension and the incidence of CKD and identify the impacts of gender and ethnic differences.

Methods: MEDLINE, EMBASE, Cochrane Library (from inception through March 2016) and article reference lists were searched for relevant studies regarding blood pressure and CKD. Blood pressure (BP) measurements were classified as follows: optimal BP (less than 120/80 mmHg), prehypertension (120-139/80-89 mmHg) and hypertension (over 140/90 mmHg). CKD was defined by estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m2 or proteinuria. Two investigators independently extracted the data and assessed the quality of studies enrolled in this meta-analysis using the Newcastle-Ottawa Scale (NOS). We performed the meta-analysis using Stata/SE 12.0 (StataCorp LP). The random-effect models were used in the heterogeneous analyses.

Results: After retrieving data from 4,537 potentially relevant articles, we identified 7 cohort studies including 261,264 subjects, according to the predefined selection criteria. Five studies were conducted in Mongolians from East Asia, and the other two studies were performed in Indo-Europeans from Austria and Iran. The participants ranged in age from 20 to 89 years, and the proportion of females ranged from 27.2% to 63.8%. The follow-up period ranged from 2 to 11 years. Compared with the optimal BP values, prehypertension showed an increased risk of CKD (pooled RR = 1.28; 95% CI = 1.13-1.44; P = 0.000; I2 = 77.9%). In the sex-stratified analysis, we found a similar trend in women (pooled RR = 1.29; 95% CI = 1.01-1.63; P = 0.039; I2 = 76.1%) but not in men. This effect was observed only in Mongolians from East Asia (pooled RR = 1.37; 95% CI = 1.18-1.59; P = 0.000; I2 = 81.3%) and not in Indo-Europeans.

Conclusions: Prehypertension is considered a potential cause of CKD. Gender and ethnic differences are exhibited in this association.

Publication types

Meta-Analysis

MeSH terms

Ethnicity
Female
Humans
Kidney Failure, Chronic / complications*
Kidney Failure, Chronic / physiopathology
Male
Prehypertension / complications*
Prehypertension / physiopathology

Grants and funding

This work was supported by 1) Name:Key Project of Chinese National Program for Fundamental Research and Development (973 Program). Grant Numbers 2012CB517803 to LMC. URLs: http://www.973.gov.cn/English/Index.aspx; and 2)Name:National Natural Scientific Foundation, China. Grant Number: 81170674, 81470937 to LMC. URLs: http://www.nsfc.gov.cn/publish/portal1/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.