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. 2024 Dec 1;35(12):1737-1745.
doi: 10.1681/ASN.0000000000000459. Epub 2024 Jul 30.

The Legacy Effect of Intensive versus Standard BP Control on the Incidence of Needing Dialysis or Kidney Transplantation

Nicholas M Pajewski  1 , Srinivasan Beddhu  2 , Adam P Bress  3 , Tara I Chang  4 , Glenn M Chertow  4 , Alfred K Cheung  2 , William C Cushman  5 , Barry I Freedman  6 , Tom Greene  3 , Karen C Johnson  5 , Byron C Jaeger  1 , Manjula Kurella Tamura  4   7 , Cora E Lewis  8 , Mahboob Rahman  9 , David M Reboussin  1 , Michael V Rocco  6 , Jeff D Williamson  10 , Paul K Whelton  11 , Jackson T Wright Jr  8 , Paul E Drawz  12 , Joachim H Ix  13
Affiliations

The Legacy Effect of Intensive versus Standard BP Control on the Incidence of Needing Dialysis or Kidney Transplantation

Nicholas M Pajewski et al. J Am Soc Nephrol. .

Abstract

Key Points:

  1. In the Systolic Blood Pressure Intervention Trial (SPRINT), the longer-term incidence of needing dialysis or transplantation was low and primarily associated with baseline kidney function.

  2. Rates of dialysis or transplantation were higher with intensive versus standard treatment, though the differences were not statistically significant.

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive lowering of systolic BP increased the risk of incident CKD and episodes of AKI. Whether intensive treatment changes the risk of kidney failure is unknown. The goal of this study was to estimate the legacy effect of intensive versus standard systolic BP lowering on the longer-term incidence of kidney failure.

Methods: This study is a secondary analysis of a randomized, open-label clinical trial with observational follow-up. Between 2010 and 2013, patients 50 years and older with hypertension and higher cardiovascular risk excluding those with diabetes mellitus, history of stroke, proteinuria >1 g/d, or polycystic kidney disease were recruited from 102 clinic sites in the United States and Puerto Rico. Participants were randomized to a systolic BP goal of <120 mm Hg (intensive treatment) or <140 mm Hg (standard treatment group). We linked participants with the United States Renal Data System to ascertain kidney failure (initiation of dialysis therapy or transplantation) and the US National Death Index to ascertain all-cause mortality through 2020.

Results: Based on analysis of 9279 (99.1%) of 9361 randomized participants, 101 cases of kidney failure occurred over a median follow-up of 8.6 years (interquartile range, 8.0–9.1 years), with the majority occurring in 74 (73.3%) participants with an eGFR <45 ml/min per 1.73 m2 at baseline. Intensive treatment did not significantly increase the risk of kidney failure either overall (cause-specific hazard ratio, 1.20; 95% confidence interval, 0.81 to 1.78) or in the subgroup of participants with baseline eGFR <45 ml/min per 1.73 m2 (cause-specific hazard ratio, 1.43; 95% confidence interval, 0.89 to 2.30).

Conclusions: Overall, and in patients with eGFR <45 ml/min per 1.73 m2, there were higher rates of dialysis or transplantation among SPRINT participants randomized to intensive treatment, but the modest differences observed were not statistically significant.

Clinical Trial registry name and registration number:: SPRINT, NCT01206062.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/E792.

References

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    1. Zhang W Zhang S Deng Y, et al. . Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385(14):1268–1279. doi:10.1056/NEJMoa2111437 - DOI - PubMed
    1. He J Ouyang N Guo X, et al. . Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet. 2023;401(10380):928–938. doi:10.1016/S0140-6736(22)02603-4 - DOI - PubMed
    1. Whelton PK Carey RM Aronow WS, et al. . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138(17):e426–e483. doi:10.1161/CIR.0000000000000597 - DOI - PubMed
    1. Cheung AK Chang TI Cushman WC, et al. . Executive summary of the KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021;99(3):559–569. doi:10.1016/j.kint.2020.10.026 - DOI - PubMed

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