ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR081

Urinary Biomarkers of Kidney Damage and Incident CKD in SPRINT

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Zhang, William R., UCSF School of Medicine, San Francisco, California, United States
  • Craven, Timothy, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Malhotra, Rakesh, UCSD, San Diego, California, United States
  • Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
  • Chonchol, Michel, University of Colorado , Aurora, Colorado, United States
  • Drawz, Paul E., University of Minnesota, Minneapolis, Minnesota, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States
  • Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States
  • Ix, Joachim H., UCSD, San Diego, California, United States
Background

Randomization to the intensive arm (SBP<120mmHg) in the Systolic Blood Pressure Intervention Trial (SPRINT) was associated with a 3-fold increased incidence of CKD, compared with the standard arm (SBP<140mmHg). However, it is unknown whether incident CKD in the setting of intensive SBP lowering is accompanied by intrinsic kidney injury.

Methods

Among the 162 incident CKD cases (128 in the intensive arm and 34 in the standard arm) that occurred during SPRINT follow-up and 162 controls matched on age, sex, race, baseline eGFR, and randomization arm, we measured 9 validated urinary biomarkers of kidney damage at baseline and 1 year. Linear mixed-effects models adjusting for baseline SBP and urine creatinine estimated 1-year biomarker changes to compare incident CKD cases vs. matched controls in the intensive arm; and to contrast cases in the intensive vs. standard arms.

Results

At 1 year of SPRINT follow-up, incident CKD cases vs. matched controls in the intensive arm had mean eGFR declines of -22 vs. -4 mL/min/1.73m2. However, incident CKD cases in the intensive arm had either significantly greater 1-year reductions or similar changes of kidney damage biomarkers, compared with both matched controls and with cases in the standard arm (Figure).

Conclusion

Incident CKD cases in the intensive arm had substantial 1-year eGFR reductions yet did not have relative increases in biomarkers, compared with matched controls; rather, these cases had decreases in several biomarkers, compared with both matched controls and cases in the standard arm. Thus, incident CKD in the setting of intensive SBP lowering may reflect hemodynamic accommodation rather than intrinsic injury.

1-year percent changes of nine urinary biomarkers among incident CKD cases and matched controls, stratified by randomization arm, in SPRINT.

Funding

  • NIDDK Support