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. 2025 Jan 2;8(1):e2453458.
doi: 10.1001/jamanetworkopen.2024.53458.

SPRINT Treatment Among Adults With Chronic Kidney Disease From 2 Large Health Care Systems

Manjula Kurella Tamura  1   2 , Mengjiao Huang  2 , Jaejin An  3 , Mengnan Zhou  3 , Fang Niu  3 , John J Sim  4 , Nicholas M Pajewski  5 , Sarah A Gaussoin  5 , June Li  1   6 , Michelle C Odden  2   6 , Tara I Chang  1 , Vivek Charu  7   8 , Maria E Montez-Rath  1
Affiliations

SPRINT Treatment Among Adults With Chronic Kidney Disease From 2 Large Health Care Systems

Manjula Kurella Tamura et al. JAMA Netw Open. .

Abstract

Importance: It is unclear whether the effects of intensive vs standard blood pressure (BP) targets seen in clinical trials generalize to patients with chronic kidney disease (CKD) encountered in everyday practice due to differences in the distribution of cardiovascular risk factors and coexisting conditions.

Objective: To evaluate whether the beneficial and adverse effects of intensive vs standard BP control observed in the Systolic Blood Pressure Intervention Trial (SPRINT) are transportable to a target population of adults with CKD in clinical practice.

Design, setting, and participants: This comparative effectiveness study identified 2 populations with CKD who met the eligibility criteria for SPRINT between January 1 and December 31, 2019, in the Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC). Baseline covariate, treatment, and outcome data from SPRINT were combined with covariate data from these populations to estimate the treatment effects in the target population, applying models that estimated outcomes using distributions in the trial. Analysis was performed between May 2023 and October 2024.

Main outcomes and measures: The main outcomes were major cardiovascular events, all-cause death, cognitive impairment, CKD progression, and adverse events at 4 years.

Results: A total of 85 938 patients (mean [SD] age, 75.7 [10.0] years; 81 628 [95.0%] male) from the VHA and 13 983 patients (mean [SD] age, 77.4 [9.6] years; 5371 [38.4%] male) from KPSC were included. Compared with 9361 SPRINT participants (mean [SD] age, 67.9 [9.4] years; 6029 [64.4%] male), these patients were older, had less prevalent cardiovascular disease, higher albuminuria, and used more statins. The associations of intensive vs standard BP control with major cardiovascular events, all-cause death, and adverse events were transportable from the trial to the VHA and KPSC populations; however, the trial's effects on cognitive and CKD outcomes were not transportable in 1 or both clinical populations. Intensive vs standard BP treatment was associated with lower absolute risks for major cardiovascular events at 4 years by 5.1% (95% CI, -9.8% to 3.2%) in the VHA population and 3.0% (95% CI, -6.3% to 0.3%) in the KPSC population and higher risks for adverse events by 1.3% (95% CI, -5.5% to 7.7%) in the VHA population and 3.1% (95% CI, -1.5% to 8.3%) in the KPSC population.

Conclusions and relevance: In this comparative effectiveness study, the reduction in fatal and nonfatal cardiovascular end points and the increase in adverse events observed in SPRINT were largely transportable to trial-eligible CKD populations from clinical practice, suggesting benefits of implementing intensive BP targets.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kurella Tamura reported serving as a consultant for the American Federation of Aging Research and Deputy Editor for Journal of the American Society of Nephrology outside the submitted work. Dr An reported receiving grants from Bayer, AstraZeneca, Merck, and Patient-Centered Outcomes Research Institute outside the submitted work. Dr Chang reported receiving personal fees from Novo Nordisk, AstraZeneca, and Bayer; consulting fees from CSL Behring (paid to institution); consulting fees from ProKidney and Alexion (paid to George Clinical); and personal fees from George Clinical outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Risk Ratios (RRs) for the Primary and Secondary Outcomes and Adverse Events at 4 Years With Intensive vs Standard Blood Pressure Treatment in Adults With Chronic Kidney Disease, Stratified by Health System
Transportability is based on estimate agreement, ie, the target mean treatment risk ratio falls within the 95% CI of the trial mean treatment risk ratio. CV indicates cardiovascular; CVD, CV disease; eGFR, estimated glomerular filtration rate; KPSC, Kaiser Permanente of Southern California; SPRINT, Systolic Pressure Intervention Trial; VHA, Veterans Health Administration.
Figure 2.
Figure 2.. Risk Ratios (RRs) for the Primary and Secondary Outcomes and Adverse Events at 4 Years With Intensive vs Standard Blood Pressure Treatment in Adults With Advanced Chronic Kidney Disease, Stratified by Health System
Kaiser Permanente of Southern California (KPSC) and Veterans Health Administration (VHA) populations are further divided by estimated glomerular filtration rate (eGFR). Transportability is based on estimate agreement, ie, the target average treatment risk ratio falls within the 95% CI of the trial mean treatment risk ratio. CV indicate cardiovascular; CVD, CV disease; SPRINT, Systolic Pressure Intervention Trial.
Figure 3.
Figure 3.. Risk Difference for Intensive vs Standard Blood Pressure Treatment in the Primary Cardiovascular Outcome, All-Cause Death, and Serious Adverse Events in the Trial, Veterans Health Administration (VHA) Chronic Kidney Disease (CKD), and Kaiser Permanente of Southern California (KPSC) CKD Populations
CV indicates cardiovascular; NNH, number needed to harm; NNT, number needed to treat.
See this image and copyright information in PMC

References

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