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Kidney Week

Abstract: FR-PO245

Meta-Analysis on the Effects of Intensive (INT) Blood Pressure (BP) Control on Incident CKD and ESRD

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Agarwal, Adhish, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Bjordahl, Terrence S., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Simmons, Debra Lynn, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Fried, Linda F., VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Sugar Land, Texas, United States
Background

We examined the hypothesis that the effects of INT BP control on kidney outcomes could differ by the level of baseline kidney function.

Methods

We performed a literature search and included studies that met one of the following criteria: 1. included participants without CKD at baseline and data for incident CKD were available and 2. included participants with stage 3/ 4CKD and data for ESRD available. We excluded BP studies that randomized by medications but not a BP goal, lifestyle intervention studies, with follow-up < 1 year or did not report the above outcomes. The estimates were pooled using a random effects model.

Results

Of the 3470 potentially relevant studies, 30 studies were extracted and 8 studies were included for analysis. There were 625 incident CKD events in 6560 non-CKD participants in 3 studies (Fig 1). Compared to the standard BP goal, intensive BP lowering had higher risk of incident CKD (RR 2.08, 95% CI 1.41 to 3.05). There were 210 ESRD events in 2759 CKD participants during the trial phase in 7 studies (Fig 2, panel A) with a RR of 0.94 (95% CI 0.79-1.12) for intensive vs. standard BP control. Two (MDRD and AASK) studies reported legacy folllow-up ; including these there were 483 ESRD events with a RR of 0.91, 95% CI 0.82-1.01 (Fig 2, panel B).

Conclusion

While INT BP lowering has higher risk of incident CKD in non-CKD, it might potentially reduce the risk of ESRD in CKD. Further RCTs of INT BP lowering in CKD participants are warranted to establish the risk-benefit ratio.

Effects of intensive BP control on incident CKD in non-CKD participants

Effects of intensive BP control on ESRD in participants with CKD in main trial phase (panel A) and entire legacy follow-up (panel B)