Long-term progression of hypertensive nephropathy (nephrosclerosis)

Abstract

Background: Over the last 30 years, there has been an increase in the number of patients with hypertensive nephropathy. Nephrosclerosis is now one of the most common causes of end stage renal disease (ESRD). The objective of this study was to observe the long-term progression of nephrosclerosis regarding renal replacement therapy (RRT), hospitalizations due to kidney disease and death.

Methods: This was a prospective cohort study of 1440 participants in the Nord-Trøndelag health study (HUNT), who fulfilled our clinical criteria for nephrosclerosis. Follow-up data from the latest HUNT survey and national health registries was used.

Results: The prevalence of nephrosclerosis was 3.0 %. The mean age of the 1440 nephrosclerosis patients was 76.6 ±8.5 years (range 28.7 – 96.5). The patients had a mean estimated glomerular filtration rate (eGFR) 49.8 ±9.1 ml/min/1.73 m2, using the CKD-EPI equation. 47.6 % of the patients were dead after 14 years of follow-up. The most common cause of death was cardiovascular(53.3 %). The nephrosclerosis patients had a significantly lower survival at any time, compared with the general population without nephrosclerosis when age was adjusted to 70 years. 1.7 % of the patients experienced progression to ESRD, during the follow-up period. The nephrosclerosis patients also had a significantly higher risk for RRT. Most hospital admittances due to a kidney disease were classified as chronic kidney disease (71 %), but acute kidney injury (AKI) accounted for as much as 11.5 % of all the hospitalizations.

Conclusion: Nephrosclerosis is a common condition in the general population, and it is associated with increased mortality and risk for RRT.