Research Als

SIGNFICANCE

Chronic Kidney Disease and Hypertension in Adults

Chronic kidney disease (CKD) is estimated to affect 16 million individuals in the United States and is associated with a high risk of morbidity and mortality.1,2 There are over 500,000 patients either on dialysis or with a kidney transplant as a result of end-stage renal disease (ESRD).3 Only better blood pressure control, treatment with ACE inhibitors and angiotensin-receptor blockers (ARBs) and glycemic control in diabetics have been shown to slow the progression of kidney disease.4-8 Blood pressure control seems especially important in proteinuric kidney disease.9 Major abnormalities associated with CKD include hypertension, anemia, low serum bicarbonate, albumin and calcium levels and high serum phosphate and parathyroid hormone (PTH) levels. 10,11

CKD, hypertension, and most importantly their consequences, ESRD and cardiovascular disease, are disproportionately suffered by the poor and by ethnic minorities. We are proposing to test an inexpensive intervention in a population in the Bronx where among its 1.4 million residents 43% are African American and 52% Hispanic. About 30% of the population has incomes below the Federal poverty level. Moreover, the Bronx has the highest incidence of ESRD of any of the 5 boroughs of New York City, an incidence rate that is more than 1/3 greater than the national average.3 In addition, we will test the intervention in adolescents attending a kidney disease clinic in Manhattan who come from Manhattan, the Bronx and Queens, three New York City boroughs with diverse populations. More effective intervention is clearly needed in populations such as those in New York City.

Chronic Kidney Disease and Hypertension in Adolescents

In the general population, as surveyed in the National Health and Nutrition Examination surveys (NHANES), blood pressures among children and adolescents have risen over the past 20 years, partially attributable to increased...