Chinnadurai R, Wu HHL, Abuomar J, Rengarajan S, New DI, Green D, Kalra PA. Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease: Findings from the Salford Kidney Study. World J Nephrol 2023; 12(5): 168-181 [PMID: 38230298 DOI: 10.5527/wjn.v12.i5.168]
Corresponding Author of This Article
Rajkumar Chinnadurai, MD, PhD, Consultant Physician-Scientist, Doctor, Senior Lecturer, Donal O’Donoghue Renal Research Centre & Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom. rajkumar.chinnadurai@nca.nhs.uk
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Dec 25, 2023; 12(5): 168-181 Published online Dec 25, 2023. doi: 10.5527/wjn.v12.i5.168
Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease: Findings from the Salford Kidney Study
Rajkumar Chinnadurai, Henry H L Wu, Jones Abuomar, Sharmilee Rengarajan, David I New, Darren Green, Philip A Kalra
Rajkumar Chinnadurai, Sharmilee Rengarajan, David I New, Darren Green, Philip A Kalra, Donal O’Donoghue Renal Research Centre & Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom
Henry H L Wu, Department of Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital & The University of Sydney, St. Leonards (Sydney) 2065, New South Wales, Australia
Jones Abuomar, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M1 7HR, United Kingdom
Author contributions: Chinnadurai R drafted the manuscript, led the design and oversight of the study, led the data analysis, and participated in drafting and revising the manuscript; Wu HHL drafted the manuscript and participated in revising the manuscript; Abuomar J participated in the design of the study and led data collection; Rengarajan S participated in the design of the study and assisted in data collection; New D participated in revising the manuscript; Green D participated in revising the manuscript; Kalra PA supervised the design and oversight of the study and participated in revising the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the North West - Greater Manchester South Research Ethics Committee in the United Kingdom.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrolment.
Conflict-of-interest statement: The authors of this manuscript declare that they have no conflicts of interest to disclose in relation to the contents of this study.
Data sharing statement: There are no additional data available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rajkumar Chinnadurai, MD, PhD, Consultant Physician-Scientist, Doctor, Senior Lecturer, Donal O’Donoghue Renal Research Centre & Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom. rajkumar.chinnadurai@nca.nhs.uk
Received: August 20, 2023 Peer-review started: August 20, 2023 First decision: September 14, 2023 Revised: September 20, 2023 Accepted: October 23, 2023 Article in press: October 23, 2023 Published online: December 25, 2023 Processing time: 123 Days and 13.9 Hours
ARTICLE HIGHLIGHTS
Research background
Hypertension is a major contributor towards the progression of chronic kidney disease (CKD) and a leading consequence of CKD. Despite standard guidelines, clinician practices on managing hypertension in CKD patients remain variable.
Research motivation
It is important to explore the factors relating to CKD patients that influences a clinician’s decision to use specific antihypertensive agents with the aim to better standardize current antihypertensive prescription practices.
Research objectives
To investigate hypertension management practices in CKD patients within a real-world setting.
Research methods
We retrospectively analysed patients recruited into the Salford Kidney Study database. Data including patient demographic information, comorbidities, and a detailed antihypertensive medication history were reviewed. Prescription patterns of antihypertensive agents were explored based on estimated glomerular filtration rate expressed as mL/min/1.73 m2, urine albumin-creatinine ratio, primary kidney disease aetiology, and cardiovascular disease. The association between being prescribed three or more antihypertensive agents and clinical outcomes (i.e. all-cause mortality and reaching end stage kidney disease) was also studied.
Research results
A total of 3230 non-dialysis dependent CKD patients with data collected between October 2002 and December 2019 were included. The most frequently prescribed antihypertensive agents were renin angiotensin system blockers (61%), followed by diuretics (47%), dihydropyridine calcium channel blockers (39%), and beta blockers (34%). A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages (53% of CKD stage 5 patients vs 26% of CKD stage 2 patients) and as the urine albumin-creatinine ratio increased (category A3: 62% vs category A1: 40%, P < 0.001). The prescription of three or more antihypertensive agents was associated with all-cause mortality, independent of blood pressure control (hazard ratio: 1.15; 95% confidence interval: 1.04-1.27, P = 0.006).
Research conclusions
Renin angiotensin system blockers were found to be the most prescribed antihypertensive agents, followed by diuretics and calcium channel blockers. Outcomes were poorer in CKD patients with poor blood pressure control despite being on multiple antihypertensive agents.
Research perspectives
Our study results aligned with expectations from the current National Institute of Health and Care Excellence guideline algorithm; further work determining optimal strategies in approaching antihypertensive prescriptions for CKD patients at both an individual and policy level is needed to reduce the variations currently observed in clinical practice.
