Kidney Week

Abstract: SA-OR051

Long-Term Kidney Effects of Intensive (INT) SBP Lowering in Persons with Type 2 Diabetes Mellitus (T2DM): ACCORD BP and ACCORDION

Session Information

• Hypertension and CVD: Epidemiology and Outcomes
  October 27, 2018 | Location: 6F, San Diego Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Beddhu, Srinivasan, University of Utah, Salt Lake City, Utah, United States

Srinivasan Beddhu, MD

• Boucher, Robert E., University of Utah, Salt Lake City, Utah, United States

Robert E. Boucher,

• Wei, Guo, University of Utah, Salt Lake City, Utah, United States

Guo Wei,

• Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States

Alfred K. Cheung,

• Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States

Glenn Matthew Chertow,

• Ambrosius, Walter T., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

Walter T. Ambrosius,

• Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States

William C. Cushman,

• Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Paul K. Whelton,

• Greene, Tom, University of Utah, Salt Lake City, Utah, United States

Tom Greene,

Background

We recently reported that INT SBP lowering increased the risk of incident CKD in T2DM. It is unclear whether this risk persists long-term after discontinuation of INT SBP control.

Methods

ACCORD BP tested the effects of SBP goal < 120 vs. < 140 mm Hg on CV outcomes in T2DM. ACCORDION was a long-term, post-trial, off-intervention, cohort follow-up of ACCORD participants. We examined the long-term trajectories of SBP and eGFR using mixed models. In separate Cox regression models, we related the intervention 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 = 4305) and to a composite of 50% decline in eGFR or incident stage IV CKD (<30 ml/min/1.73 m²) in all participants (N = 4733).

Results

SBP and eGFR trajectories are depicted in Fig 1. Mean differences in SBP and eGFR between the treatment arms are also summarized in Fig 1. INT SBP lowering resulted in increased risk of incident CKD in ACCORD BP which attenuated after the intervention was discontinued during ACCORDION (Fig 2), interaction p = 0.02; the pattern was similar for 50% decline/ stage IV CKD but the interaction p value (0.24) was not significant.

Conclusion

In persons with T2DM, INT SBP lowering resulted in a decline in eGFR and higher risk of kidney events which appeared to attenuate after discontinuation of the intervention.

SBP and eGFR trajectories

Hazard ratios for kidney events with INT SBP lowering in ACCORD BP and ACCORDION follow-up

Funding

• NIDDK Support