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Chronic kidney disease in hypertension under specialist care: the I-DEMAND study

Leoncini, Giovannaa,b; Viazzi, Francescaa,b; Rosei, Enrico Agabitic; Ambrosioni, Ettored; Costa, Francesco Vd; Leonetti, Gastonee; Pessina, Achille Cf; Trimarco, Brunog; Volpe, Massimoh; Deferrari, Giacomoa,b; Pontremoli, Robertoa,b

doi: 10.1097/HJH.0b013e328332038c
Original papers: Kidney

Objective and methods Italy Developing Education and awareness on MicroAlbuminuria in patients with hyperteNsive Disease is an observational, cross-sectional, multicenter study aimed at determining prevalence and correlates of chronic kidney disease (CKD) among Italian hypertensive patients attending out-patient referral clinics. CKD was defined as glomerular filtration rate (GFR) less than 60 ml/min per 1.73 m2 (Modification of Diet in Renal Disease equation) or urine albumin to creatinine ratio of at least 2.5 mg/mmol in men and of at least 3.5 mg/mmol in women or both.

Results Among 3534 study patients (mean age 61 years, 54% male patients, 37% diabetic patients), the prevalence of microalbuminuria, reduced GFR, and CKD was 27, 26, and 42%, respectively. Only 11% of patients had concomitant microalbuminuria and reduced GFR. Sex, smoking, systolic blood pressure, glucose, and GFR were the independent predictors of albumin to creatinine ratio, whereas sex, age, history of cardiovascular diseases, uric acid, abdominal obesity, and albumin to creatinine ratio were more closely related to GFR. The presence of CKD was associated with older age, smoking, higher systolic and pulse pressure levels, impaired fasting glucose, hyperuricemia, and previous cardiovascular disease. Furthermore, CKD was not only associated with a greater use of renin–angiotensin system-inhibiting, lipid-lowering and antiplatelet drugs but also with inadequate blood pressure control.

Conclusion Renal abnormalities are found in a significant number of hypertensive patients. CKD occurs more often in older patients and in those with associated metabolic risk factors or clinical conditions. These results suggest the need to improve awareness of the role of renal damage as a component of global risk and to develop appropriate therapeutic strategies to reduce morbidity and mortality in this specific subgroup of patients.

aDepartment of Internal Medicine, University of Genoa, Italy

bDepartment of Cardionephrology, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy

cDepartment of Internal Medicine, University of Brescia, Brescia, Italy

dDepartment of Internal Medicine, University of Bologna, Bologna, Italy

eIstituto Auxologico Italiano, Ospedale S. Luca, Milan, Italy

fDepartment of Clinical and Experimental Medicine, University of Padua, Padua, Italy

gDepartment of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy

hCardiology Department, Second Faculty of Medicine, University of Rome ‘La Sapienza’, Rome, Italy

Received 12 May, 2009

Revised 11 August, 2009

Accepted 18 August, 2009

Correspondence to Professor Roberto Pontremoli, MD, PhD, Department of Internal Medicine, University of Genoa, and Department of Cardio-Nephrology, Azienda Ospedaliera Universitaria San Martino, Genoa, Viale Benedetto XV, 6 – 16132 Genoa, Italy Tel: +39 010 353 8932; fax: +39 010 353 8932; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.