Abstract: TH-OR032

Intensive Systolic Blood Pressure (SBP) Control and Incident CKD in Persons with and without Diabetes Mellitus (DM)

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Authors

  • Beddhu, Srini, Univ of Utah, SLC, Utah, United States
  • Cheung, Alfred K., Univ of Utah, SLC, Utah, United States
  • Chertow, Glenn Matthew, Stanford Univ, Palo Alto, California, United States
  • Whelton, Paul K., Tulane Univ, New Orleans, Louisiana, United States
  • Boucher, R. E., Univ of Utah, SLC, Utah, United States
  • Wei, Guo, Univ of Utah, SLC, Utah, United States
  • Kimmel, Paul L., NIDDK, Bethesda, Maryland, United States
  • Cushman, William C., VAMC, Memphis, Tennessee, United States
  • Greene, Tom, Univ of Utah, SLC, Utah, United States
Background

In Systolic Blood Pressure Intervention Trial (SPRINT), higher incidence of CKD with intensive SBP control in persons without DM was reported. It is unclear whether intensive SBP control has similar effects in DM.

Methods

SPRINT tested the effects of SBP goal < 120 vs. < 140 mm Hg on CV outcomes in persons without DM whereas Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial tested the same in type 2 DM. In separate Cox models, we related the interventions to incident CKD (defined as a >30% decrease in eGFR to a value <60 ml/min/1.73 m2) in participants without CKD at baseline (N = 6677 in SPRINT; N = 4305 in ACCORD).

Results

Baseline characteristics are summarized. (table) The absolute risks of incident CKD estimated by Kaplan Meier (KM) curves at 3 years of follow-up in standard vs. intensive arms were 1.0 vs. 3.5% in SPRINT and 4.6 vs. 11.5% in ACCORD with an absolute risk increase % (95% CI) at 3-years of 2.5 (1.8 to 3.2) in SPRINT and 6.9 (5.2 to 8.5) in ACCORD. KM failure curves and hazard ratios are presented in the figure.

Conclusion

Intensive SBP control increased the risk of incident CKD in persons with and without DM, however, absolute risk increase is higher in DM. The long-term implications of these findings need to be established.

Baseline Characteristics
 SPRINTACCORD
 Intensive
(N=3332)
Standard
(N=3345)
Intensive
(N=2148)
Standard
(N=2157)
Age (yr)66.3 ± 9.066.3 ± 9.062.3 ± 6.562.4 ± 6.6
Male (%)66675453
Black (%)34352829
SBP (mm Hg)140 ± 16140 ± 15139 ± 16139 ± 15
DBP (mm Hg)79 ± 1279 ± 1276 ± 1076 ± 10
BMI(kg/cm2)30.1 ± 5.830.0 ± 5.732.1 ± 5.632.1 ± 5.3
eGFR (ml/min/1.73 m2)81.1 ± 15.581.3 ± 15.594.2 ± 20.794.0 ± 20.8
Urine ACR (mg/g)9 (5, 17)9 (5, 17)15 (7, 44)14 (7, 45)

KM failure curves for incident CKD by treatment arm in SPRINT and ACCORD BP

Funding

  • NIDDK Support