CLINICAL CORRELATES OF HYPERTENSIVE END-STAGE RENAL-DISEASE

Although there has been much discussion regarding the etiology of hype rtensive renal disease, clinical characteristics of this condition hav e not been thoroughly studied. The purpose of this investigation was t o identify clinical correlates of hypertensive end-stage renal disease (ESRD) in a population of patients older than 50 years and to compare these clinical findings with those in a group of ESRD patients with c ertain known disorders (established diagnoses). Data regarding demogra phics, cause of ESRD, educational level, presence of diabetes mellitus , angina, myocardial infarction, and peripheral vascular disease were obtained from the Southeastern Kidney Council for patients starting re nal replacement therapy between January 1, 1990, and August 1, 1996. C linical characteristics were compared for white and black patients. De mographic variables and comorbid conditions were compared between grou ps with general linear regression or logistic regression contrast tech niques. A logistic regression model was formed with hypertensive ESRD or established diagnoses as the outcome variable and comorbid and soci oeconomic variables as the independent variables. Hypertensive ESRD wa s diagnosed in 24% of white and 38% of black patients, while establish ed diagnoses were present in 17% of white and 7% of black ESRD patient s. The most common established diagnoses were polycystic kidney diseas e, specified glomerulonephritis, and nephrolithiasis or obstruction. I n a logistic regression model, white patients were found more likely t o be classified as having hypertensive ESRD if they were older, suffer ed from angina and other forms of atherosclerosis, smoked, and were le ss educated. White patients with hypertensive ESRD were more than 2.4 times as likely to suffer from angina as patients with established dia gnoses. For black patients, the presence of peripheral vascular diseas e and female gender were associated with an increased chance of being diagnosed as having hypertensive ESRD. The results of this investigati on show that there is a strong association between atherosclerosis and hypertensive ESRD in older white patients. In black patients, the ass ociation between atherosclerosis and hypertensive ESRD was also presen t, but not as strong. The unique association of hypertensive ESRD with atherosclerosis suggests that atherosclerosis is a risk factor for ch ronic renal failure and that a primary renal microvascular disorder ma y lead to both hypertension and progressive renal insufficiency. (C) 1 998 by the National Kidney Foundation, Inc.