Effects of hypertension and dyslipidemia on the decline in renal function.

Experimental evidence suggests that in addition to hypertension, serum lipids might also accelerate the decline in renal function. We tested this hypothesis in 2702 dyslipidemic middle-aged men without renal disease participating in the Helsinki Heart Study, a coronary primary prevention trial. The decline in renal function was estimated from linear regression slopes based on reciprocals of 10 serum creatinine determinations over the study period. Renal function deteriorated 3% on average during the 5-year study, and hypertension accelerated this change. Subjects with an elevated ratio of low- to high-density lipoprotein cholesterol ( > 4.4) had a 20% faster decline than those with a ratio less than 3.2. Both the contribution of the lipoprotein ratio and the protective effect of high-density lipoprotein cholesterol alone remained significant in multiple regression analyses. In the study of joint effects the contribution of lipids was confined to subjects with simultaneous elevation of blood pressure and lipids. The results suggest that in addition to hypertension, blood lipids also modify the decline in renal function.

[1]  E. Gröne,et al.  Role of lipoproteins in progressive renal disease. , 1993, American journal of hypertension.

[2]  B. Kasiske,et al.  Hypertension, hyperlipidemia, and renal damage. , 1993, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[3]  P. Whelton,et al.  A Prospective Study of Blood Pressure and Serum Creatinine: Results From the 'Clue' Study and the ARIC Study , 1993 .

[4]  R. Neuwirth,et al.  Renal function change in hypertensive members of the Multiple Risk Factor Intervention Trial. Racial and treatment effects. The MRFIT Research Group. , 1992, JAMA.

[5]  A. Tall Metabolic and genetic control of HDL cholesterol levels , 1992, Journal of internal medicine.

[6]  J. Moorhead Lipids and the pathogenesis of kidney disease. , 1991, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[7]  J. Diamond,et al.  Analogous pathobiologic mechanisms in glomerulosclerosis and atherosclerosis. , 1991, Kidney international. Supplement.

[8]  R. Lindeman,et al.  Overview: renal physiology and pathophysiology of aging. , 1990, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[9]  S. Rosansky,et al.  The association of blood pressure levels and change in renal function in hypertensive and nonhypertensive subjects. , 1990, Archives of internal medicine.

[10]  J. Fleg,et al.  The Age‐Associated Decline in Glomerular Filtration in Healthy Normotensive Volunteers , 1990, Journal of the American Geriatrics Society.

[11]  E. Gröne,et al.  Receptor mediated uptake of apo B and apo E rich lipoproteins by human glomerular epithelial cells. , 1990, Kidney international.

[12]  B. Kasiske,et al.  Lipids and the kidney. , 1990, Hypertension.

[13]  A. Levey,et al.  Creatinine filtration, secretion and excretion during progressive renal disease. Modification of Diet in Renal Disease (MDRD) Study Group. , 1989, Kidney international. Supplement.

[14]  S. Klahr,et al.  Role of dietary lipids and renal eicosanoids on the progression of renal disease. , 1989, Kidney international. Supplement.

[15]  S. Gullans,et al.  Early effects of uranyl nitrate on respiration and K+ transport in rabbit proximal tubule. , 1989, Kidney international.

[16]  M. Blaufox,et al.  Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. , 1989, Hypertension.

[17]  P. Whelton,et al.  Hypertension as a Risk Factor for Renal Disease Review of Clinical and Epidemiological Evidence , 1989, Hypertension.

[18]  G. Reaven Role of Insulin Resistance in Human Disease , 1988, Diabetes.

[19]  M. Karnovsky,et al.  Focal and segmental glomerulosclerosis: analogies to atherosclerosis. , 1988, Kidney international.

[20]  J. Huttunen,et al.  Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. , 1987, The New England journal of medicine.

[21]  J. Huttunen,et al.  The Helsinki Heart Study: basic design and randomization procedure. , 1987, European heart journal.

[22]  B. Kasiske Relationship between vascular disease and age-associated changes in the human kidney. , 1987, Kidney international.

[23]  B. Kasiske,et al.  Renal disease in patients with massive obesity. , 1986, Archives of internal medicine.

[24]  N W Shock,et al.  Longitudinal Studies on the Rate of Decline in Renal Function with Age , 1985, Journal of the American Geriatrics Society.

[25]  N. Shock,et al.  Association between blood pressure and the rate of decline in renal function with age. , 1984, Kidney international.

[26]  W. Mitch,et al.  A SIMPLE METHOD OF ESTIMATING PROGRESSION OF CHRONIC RENAL FAILURE , 1976, The Lancet.

[27]  A. H. Norris,et al.  The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. , 1976, Journal of gerontology.

[28]  M. Karnovsky,et al.  A putative role of hypercholesterolemia in progressive glomerular injury. , 1992, Annual review of medicine.

[29]  B. Kasiske,et al.  The role of lipids in progressive glomerular disease. , 1987, Advances in experimental medicine and biology.

[30]  J. Miller,et al.  Chronic progressive renal disease: rate of change of serum creatinine concentration. , 1977, Kidney international.

[31]  Cockcroft Dw,et al.  Prediction of Creatinine Clearance from Serum Creatinine , 1976 .