Abstract: TH-PO462

White Matter Hyperintensities and Risk for Kidney Function Decline with Intensive Blood Pressure (BP) Lowering: The Secondary Prevention of Subcortical Strokes (SPS3) Trial

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Ikeme, Jesse C, The Kidney Health Research Collaborative at SF VAMC and UCSF, San Francisco, California, United States
  • Shlipak, Michael, The Kidney Health Research Collaborative at SF VAMC and UCSF, San Francisco, California, United States
  • Benavente, Oscar, University of British Columbia, Vancouver, British Columbia, Canada
  • Peralta, Carmen A., The Kidney Health Research Collaborative at SF VAMC and UCSF, San Francisco, California, United States
Background

Intensive BP lowering may help prevent stroke recurrence, but it can also cause rapid kidney function decline (RKFD). White matter hyperintensities (WMHs) on brain MRI are a marker of cerebral small vessel disease and may suggest small vessel disease in kidneys. We hypothesized that high WMH burden could identify stroke survivors susceptible to RKFD with intensive blood pressure (BP) lowering.

Methods

SPS3 randomized 3,020 participants with lacunar stroke to target systolic BPs 130-150 mmHg vs. <130 mmHg. We included 2,454 participants with baseline WMHs from brain MRI. We defined RKFD as ≥30% decline in eGFR from baseline to year 1. We tested for interaction between BP intervention and WMH severity on the incidence of RKFD in one year.

Results

At randomization, mean age was 63 years and eGFR 81 mL/min/1.73m2. Two hundred thirty-four (9.5%) had RKFD at one year—100 (8.1%) in the usual BP and 134 (11.0%) in the intensive BP arm (p = 0.01). The proportion with RFKD increased with higher WMH tertile (8%, 10%, and 11% from lowest to highest tertile). The association of BP target with RKFD was qualitatively higher with increasing WMH tertile (Table), but the interaction was not significant (p = 0.65).

Conclusion

Higher WMH burden was not adequate to distinguish persons most susceptible to rapid kidney function decline in the setting of intensive BP lowering after stroke.

Rapid kidney function decline (RKFD) among persons randomized to usual vs. intensive BP lowering in SPS3, stratified by WMH tertile.
BP intervention armParticipants with RKFD at year 1Odds ratio(95% CI)P
Lowest WMH tertile (n=1013)
Usual BP arm (n=498)7.2%Referent
Intensive BP arm (n=515)9.0%1.26(0.80 - 1.98)0.32
Medium WMH tertile (n=770)
Usual BP arm (n=381)8.7%Referent
Intensive BP arm (n=389)11.3%1.34(0.84 - 2.16)0.22
Highest WMH tertile (n=671)
Usual BP arm (n=357)8.7%Referent
Intensive BP arm (n=314)14.0%1.71(1.05 - 2.80)0.03

Funding

  • Other NIH Support