Management and control of hypertension and proteinuria in patients with advanced chronic kidney disease under nephrologist care or not: data from the AVENIR study (AVantagE de la Nephroprotection dans l'Insuffisance Renale)

Background. Little is known about antihypertensive management and control of blood pressure (BP) and proteinuria in patients with chronic kidney disease (CKD). Data from a large observational study (AVENIR), carried out in Lorraine (France), were used to analyse antihypertensive treatment and control of BP and proteinuria in patients with advanced CKD, under nephrologist care or not. Methods. All adults with CKD, beginning dialysis in 2005 and 2006, were included and categorized into patients 'under nephrologist care' and 'not under nephrologist care' at the time when treatment, BP and proteinuria results were considered. All data were collected retrospectively from medical records. Demographic and clinical data were from initiation of dialysis. BP, biological and therapeutic data were results obtained at 2.7 months before dialysis for patients under nephrologist care, and results obtained at the first nephrology consultation for those not under such care (2.7 +/- 3.7 months before dialysis). Results. On 566 included patients, the 291 under nephrologist care received more antihypertensive agents (3.1 +/- 1.5 versus 2.2 +/- 1.6) than the 275 not under such care and each antihypertensive class was more often prescribed for these patients, particularly the renin-angiotensin-aldosteron system inhibitors (60.5% versus 36.7%). Nevertheless, BP did not differ between both groups, and proteinuria control was achieved in more patients not under nephrologist care, revealing a likely bias of indication. Whatever the type of care, BP < 130/80 mmHg was achieved in only one quarter of all patients and proteinuria < 0.5 g/day in only 15% of them. Conclusion. Understanding the reasons for such a poor level of hypertension and proteinuria control in CKD patients needs to be explored in further investigations.