Key result
Intensive BP lowering increases acute kidney injury risk ~64% compared to standard treatment.
Why the study?
Treating to a lower blood pressure target may increase acute kidney injury events, motivating an evaluation of adjudicated AKI incidence, severity, and kidney function recovery in SPRINT.
Does intensive systolic blood pressure lowering (<120 mm Hg) increase the risk of acute kidney injury events compared to standard treatment (<140 mm Hg) in nondiabetic adults at high risk for cardiovascular disease?
RCT (n=9,361)
Open-label (with blinded outcome adjudication)
Randomly assigned to intensive or standard arm
Yes
Does intensive systolic blood pressure lowering (<120 mm Hg) increase the risk of acute kidney injury events compared to standard treatment (<140 mm Hg) in nondiabetic adults at high risk for cardiovascular disease?
Intensive blood pressure lowering to <120 mm Hg significantly increases the incidence of hospitalized or emergency department acute kidney injury events compared to standard targets, though most events are mild (KDIGO stage 1) and resolve completely.
Answers are grounded in this paper and cite their sources.
Intensive SBP lowering increases AKI risk; confirms renal trade-offs in SPRINT despite CV benefits.
Background Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. Study Design Data on 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 9361 participants aged 50 or older with one or more risk factors for cardiovascular disease. Interventions Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140 mm Hg (standard arm). Outcomes & Measurements The primary outcome was the number of adjudicated AKI events. Secondary outcomes included the severity of AKI and the degree of recovery of kidney function after an AKI event. Baseline creatinine was defined as the most recent SPRINT outpatient creatinine value prior to 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 the 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 The 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 the majority of participants had complete recovery of kidney function. TRIAL REGISTRATION www.ClinicalTrials.gov; study number: NCT01206062.
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Rocco et al. (2017) conducted an RCT in Hypertension with increased risk of cardiovascular disease (n=9,361). Intensive systolic blood pressure lowering vs. Standard systolic blood pressure lowering (target SBP <140 mm Hg) was evaluated on Adjudicated acute kidney injury (AKI) events resulting in or during hospitalization or emergency department visits (HR 1.64, 95% CI 1.30-2.10, p=<0.001). Intensive blood pressure lowering (SBP <120 mm Hg) increased the risk of acute kidney injury events compared to standard treatment (3.8% vs 2.3%; HR 1.64, 95% CI 1.30-2.10, p<0.001).
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