Acute Declines in Renal Function during Intensive BP Lowering: Implications for Future ESRD Risk
Key result
A 5% to <20% eGFR decline during intensive BP lowering did not increase ESRD risk compared to a <5% decline in usual BP control (AASK aHR 1.19, 95% CI 0.84-1.68; MDRD aHR 1.08, 95% CI 0.84-1.40).
Why the study?
Does acute decline in eGFR during intensive BP lowering associate with a higher risk of ESRD in patients with CKD?
Population
1,660 participants with chronic kidney disease
Comparison
Intensive (strict) blood pressure lowering vs Usual blood pressure control
Design
Cohort
Authors
Discussion
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Implication
Moderate eGFR declines during intensive BP lowering were not associated with higher ESRD risk; hypothesis-generating and should not yet change practice.
Study Design
Type
Cohort (n=1,660)
Multicenter
Yes
Structured PICO
Does acute decline in eGFR during intensive BP lowering associate with a higher risk of ESRD in patients with CKD?
P
Population
1,660 participants with chronic kidney disease (899 from the African American Study of Kidney Disease and Hypertension [AASK] and 761 from the Modification of Diet in Renal Disease [MDRD] Trial)
I
Intervention
Intensive (strict) blood pressure lowering
C
Comparator
Usual blood pressure control
O
Outcome
End-stage renal disease (ESRD)hard clinical
Main Result
Effect estimate: aHR 1.19 (95% CI 0.84 to 1.68)
Acute eGFR declines of 5% to <20% during intensive BP lowering do not increase ESRD risk, but declines ≥20% identify patients at higher risk for adverse outcomes.
Cite This Study
Ku et al. (2017) conducted a cohort in Chronic Kidney Disease (n=1,660). Intensive BP lowering with 5% to <20% eGFR decline vs. Usual BP control with <5% eGFR decline was evaluated on End-stage renal disease (ESRD) (aHR 1.19, 95% CI 0.84 to 1.68). A 5% to <20% eGFR decline during intensive BP lowering did not increase ESRD risk compared to a <5% decline in usual BP control (AASK aHR 1.19, 95% CI 0.84-1.68; MDRD aHR 1.08, 95% CI 0.84-1.40).