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Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Kidney Dis 2018 03;71(3):352-361

Date

11/23/2017

Pubmed ID

29162340

Pubmed Central ID

PMC5828778

DOI

10.1053/j.ajkd.2017.08.021

Abstract

BACKGROUND: Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events.

STUDY DESIGN: Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT).

SETTING & PARTICIPANTS: 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease.

INTERVENTIONS: Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140mmHg (standard arm).

OUTCOMES & MEASUREMENTS: Primary outcome was the number of adjudicated AKI events. Secondary outcomes included severity of AKI and degree of recovery of kidney function after an AKI event. Baseline creatinine concentration was defined as the most recent SPRINT outpatient creatinine value before the date of the AKI event.

RESULTS: There were 179 participants with AKI events in the intensive arm and 109 in the standard arm (3.8% vs 2.3%; HR, 1.64; 95% CI, 1.30-2.10; P<0.001). Of 288 participants with an AKI event, 248 (86.1%) had a single AKI event during the trial. Based on modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria for severity of AKI, the number of AKI events in the intensive versus standard arm by KDIGO stage was 128 (58.5%) versus 81 (62.8%) for AKI stage 1, 42 (19.2%) versus 18 (14.0%) for AKI stage 2, and 42 (19.2%) versus 25 (19.4%) for AKI stage 3 (P=0.5). For participants with sufficient data, complete or partial resolution of AKI was seen for 169 (90.4%) and 9 (4.8%) of 187 AKI events in the intensive arm and 86 (86.9%) and 4 (4.0%) of 99 AKI events in the standard arm, respectively.

LIMITATIONS: Trial results are not generalizable to patients with diabetes mellitus or without risk factors for cardiovascular disease.

CONCLUSIONS: More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function.

TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT01206062.

Author List

Rocco MV, Sink KM, Lovato LC, Wolfgram DF, Wiegmann TB, Wall BM, Umanath K, Rahbari-Oskoui F, Porter AC, Pisoni R, Lewis CE, Lewis JB, Lash JP, Katz LA, Hawfield AT, Haley WE, Freedman BI, Dwyer JP, Drawz PE, Dobre M, Cheung AK, Campbell RC, Bhatt U, Beddhu S, Kimmel PL, Reboussin DM, Chertow GM, SPRINT Research Group

Author

Dawn Felicity Wolfgram MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Aged
Antihypertensive Agents
Blood Pressure
Blood Pressure Determination
Critical Care
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Hypertension
Male
Middle Aged
Proportional Hazards Models
Reference Standards
Risk Assessment
Severity of Illness Index
Time Factors
Treatment Outcome
United States
jenkins-FCD Prod-484 8aa07fc50b7f6d102f3dda2f4c7056ff84294d1d