Blood pressure, kidney function and kidney mortality in Mexico: prospective study of 130,000 adults

Journal article

Rationale and Objective:
Chronic kidney disease (CKD) is a major cause of death in Mexico and blood pressure (BP) may be an important contributor. This study investigated the associations between BP and kidney failure mortality, CKD, and albuminuria.
Study Design:
Prospective study of 150,000 adults aged ≥35 years at recruitment (1998-2004) followed until October 2022. A subset of 10,000 survivors were resurveyed from 2015-2019.
Setting and Participants:
Participants recruited into the Mexico City Prospective Study. Analyses focused on those aged 35 to 84 years at recruitment who survived the following five years, and excluded those with baseline estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 or selfreported prior disease (except diabetes).
Exposures:
Systolic BP (SBP), diastolic BP (DBP) and hypertension (self-reported, treated or BP ≥140/90 mmHg).
Outcomes:
Kidney failure mortality, CKD (self-report and/or eGFR <60 ml/min/1.73m2 ), and albuminuria at resurvey.
Analytical Approach:
Cox regression related BP to kidney failure mortality and logistic regression related baseline BP to CKD and albuminuria at resurvey, adjusted for confounders.
Results:
Among 133,470 participants aged 35-84 years who survived the first five years, SBP showed a continuous, log-linear association with kidney failure mortality, with each 20 mmHg lower usual SBP associated with 24% lower risk at ages 40-84 (kidney failure death hazard ratio [HR] 0.76, 95% confidence interval 0.69-0.84). The association was stronger among those without diabetes (HR 0.54, 0.45–0.69) than with diabetes (HR 0.90, 0.80–1.01) but the absolute excess risk associated with higher BP was similar in those with diabetes as in those without. Excess risk associated with hypertension accounted for 9% of kidney failure deaths. Of those resurveyed, 6% had CKD and 25% had albuminuria. 20 mmHg lower baseline SBP was associated with 24% lower odds of both CKD (odds ratio [OR] 0.76, 0.68-0.85) and albuminuria (OR 0.76, 0.68-0.84) at resurvey. Results were similar for DBP.
Limitations:
Baseline urine samples were unavailable and kidney function trends over time could not be assessed.
Conclusions:
This large prospective study in Mexican adults highlights elevated BP as a major modifiable risk factor for kidney failure mortality, CKD and albuminuria.

Authors: Zhu, D; Kuri-Morales, P; Wade, R; Staplin, N; Garcilazo-Ávila, A

• Publication status: Accepted
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: American Journal of Kidney Diseases
• Acceptance date: 2026-06-25
• EISSN: 1523-6838
• ISSN: 0272-6386
• Language: English
• Keywords: blood pressure; kidney function; kidney mortality; Mexico; prospective study