Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT)
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, and Chertow GM. Effects of intensive blood pressure treatment on acute kidney injury events in the systolic blood pressure intervention trial (SPRINT). Am J Kidney Dis 2017; 71(3)352-361.
American journal of kidney diseases : the official journal of the National Kidney Foundation
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
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.