Evidence map›Paper›PMID 23798459›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2013

Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis.

Jicheng Lv, Parya Ehteshami, Mark J Sarnak, Hocine Tighiouart, Min Jun, Toshiharu Ninomiya, Celine Foote, Anthony Rodgers, Hong Zhang, Haiyan Wang and 2 more

2 registry-linked trialsAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 112 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
112citing papers in PubMed, 18 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03603938 naunknown statusnot on this mapstarted 2018, after this paper: background citation

Effect of Potassium Losartan With Bedtime Dosing on Chronic Kidney Disease Patients With Nondipping Blood Pressure Pattern

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled189ConditionsChronic Kidney Disease PatientsArmspotassium losartan
NCT03604003 naunknown statusnot on this mapstarted 2018, after this paper: background citation

Prognostic Effect of Isolated Nocturnal Hypertension Pattern With Nondialysis CKD

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled252ConditionsChronic Kidney DiseaseArmspotassium losartan
3 · Its place in the literature

Who cites it

112 citing papers in PubMed, 18 syntheses or guidelines pooled it.

  1. Guideline
  2. Evaluating blood pressure targets in chronic kidney disease: a systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2025
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Guideline
  8. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Guideline
  14. Pooled it
  15. Guideline
  16. Pooled it
  17. Assessing the Validity of Surrogate Outcomes for ESRD: A Meta-Analysis.Journal of the American Society of Nephrology : JASN · 2015
    Pooled it
  18. Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2014
    Pooled it
  19. Trial
  20. Trial

52 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Jicheng LvThe George Institute for Global Health, The University of Sydney, Sydney, Australia.
Parya Ehteshami
Mark J Sarnak
Hocine Tighiouart
Min Jun
Toshiharu Ninomiya
Celine Foote
Anthony Rodgers
Hong Zhang
Haiyan Wang
Giovanni F M Strippoli
Vlado Perkovic

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent guidelines suggest lowering the target blood pressure for patients with chronic kidney disease, although the strength of evidence for this suggestion has been uncertain. We sought to assess the renal and cardiovascular effects of intensive blood pressure lowering in people with chronic kidney disease.

methodsWe performed a systematic review and meta-analysis of all relevant reports published between 1950 and July 2011 identified in a search of MEDLINE, Embase and the Cochrane Library. We included randomized trials that assigned patients with chronic kidney disease to different target blood pressure levels and reported kidney failure or cardiovascular events. Two reviewers independently identified relevant articles and extracted data.

resultsWe identified 11 trials providing information on 9287 patients with chronic kidney disease and 1264 kidney failure events (defined as either a composite of doubling of serum creatinine level and 50% decline in glomerular filtration rate, or end-stage kidney disease). Compared with standard regimens, a more intensive blood pressure-lowering strategy reduced the risk of the composite outcome (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.68-0.98) and end-stage kidney disease (HR 0.79, 95% CI 0.67-0.93). Subgroup analysis showed effect modification by baseline proteinuria (p = 0.006) and markers of trial quality. Intensive blood pressure lowering reduced the risk of kidney failure (HR 0.73, 95% CI 0.62-0.86), but not in patients without proteinuria at baseline (HR 1.12, 95% CI 0.67-1.87). There was no clear effect on the risk of cardiovascular events or death.

interpretationIntensive blood pressure lowering appears to provide protection against kidney failure events in patients with chronic kidney disease, particularly among those with proteinuria. More data are required to determine the effects of such a strategy among patients without proteinuria.

Indexed as

Antihypertensive AgentsCardiovascular DiseasesDisease ProgressionDose-Response Relationship, DrugDrug Administration ScheduleFemaleHumansHypertensionKidney Failure, ChronicKidney Function TestsMalePractice Guidelines as TopicPrognosisRandomized Controlled Trials as TopicRenal Insufficiency, ChronicRisk AssessmentAntihypertensive Agents

Identifiers

PMID23798459
PMCPMC3735743

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.