Key result
Lower kidney tubular secretion score linked to ~16% greater adverse event risk per SD in CKD.
Why the study?
It was unknown whether novel measures of kidney tubular secretion are associated with adverse events during hypertension treatment.
Does worse kidney tubular secretion increase the risk of adverse events during hypertension treatment in patients with CKD?
Cohort (n=2,089)
Open-label
Yes
Does worse kidney tubular secretion increase the risk of adverse events during hypertension treatment in patients with CKD?
Worse kidney tubular secretion is associated with a higher risk of adverse events during hypertension treatment in patients with CKD, independent of eGFR and albuminuria.
Answers are grounded in this paper and cite their sources.
Should not yet change BP targets in CKD; leaves open tubular secretion for risk stratification in trials.
BACKGROUND: Kidney tubular secretion is an essential mechanism for clearing many common antihypertensive drugs and other metabolites and toxins. It is unknown whether novel measures of tubular secretion are associated with adverse events (AEs) during hypertension treatment. Multivariable Cox proportional hazards models were used to evaluate associations between the secretion score and risk of a composite of prespecified serious AEs (hypotension, syncope, bradycardia, AKI, electrolyte abnormalities, and injurious falls). The follow-up protocol for SPRINT routinely assessed two laboratory monitoring AEs (hyperkalemia and hypokalemia). RESULTS: Overall, 30% of participants experienced at least one AE during a median follow-up of 3.0 years. In multivariable models adjusted for eGFR and albuminuria, lower (worse) secretion scores at baseline were associated with greater risk of the composite AE outcome (hazard ratio per 1-SD lower secretion score, 1.16; 95% confidence interval, 1.04 to 1.27). In analyses of the individual AEs, lower secretion score was associated with significantly greater risk of AKI, serious electrolyte abnormalities, and ambulatory hyperkalemia. Associations were similar across randomized treatment assignment groups. CONCLUSION: Among SPRINT participants with CKD, worse tubular secretion was associated with greater risk of AEs, independent of eGFR and albuminuria.
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Bullen et al. (2022) conducted a cohort in Chronic Kidney Disease and Hypertension (n=2,089). Lower summary secretion score vs. Higher summary secretion score was evaluated on Composite of serious adverse events (hypotension, syncope, bradycardia, AKI, electrolyte abnormalities, injurious falls) and laboratory monitoring AEs (hyperkalemia, hypokalemia) (HR 1.16, 95% CI 1.04 to 1.27). Among SPRINT participants with CKD, a 1-SD lower kidney tubular secretion score was associated with a 16% greater risk of adverse events, independent of eGFR and albuminuria.
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