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Kidney Week

Abstract: PO0271

Effect of Intensive vs. Standard Blood Pressure Targets on AKI and Subsequent Cardiovascular Outcomes and Mortality

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Drawz, Paul E., University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, United States
  • Pajewski, Nicholas M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Rai, Nayanjot Kaur, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, United States
  • Lenoir, Kristin M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Ishani, Areef, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, United States
Background

Using linked electronic health record (EHR) data, this study evaluated the effect of intensive vs. standard blood pressure (BP) treatment in SPRINT on acute kidney injury (AKI) and whether incident AKI was associated with cardiovascular disease (CVD) and mortality.

Methods

Inpatient AKI was defined by a) serious adverse event (SAE) reports based on diagnosis codes and admission and discharge notes and b) a 50% or ≥0.3mg/dl increase in creatinine using EHR labs. Outpatient AKI was defined by a 50% increase in creatinine using EHR labs, compared to the most recent creatinine measured in trial follow-up. Cox regression was used to evaluate the effect of intensive BP lowering on the incidence of AKI, and to examine the time-varying association between incident AKI and CVD and mortality.

Results

3321 participants (1690 intensive vs 1631 standard) had linked EHR data. The mean age was 69 years, 23% were female, and 29% were black. More inpatient AKI events were identified using EHR labs (162 intensive vs 137 standard) as compared to SAE reporting in the trial (87 intensive vs 56 standard). Outpatient AKI similarly occurred more frequently with the inclusion of EHR labs (216 intensive vs 156 standard). Intensive treatment was associated with an increased risk for inpatient AKI based on SAE reports (HR 1.48, p=0.02) and for outpatient AKI (HR 1.36, P=0.004), but not for inpatient AKI based on EHR labs (HR 1.16, P=0.21). Irrespective of the definition, the incidence of AKI was associated with increased risk for all-cause mortality in adjusted analyses, but not with incident CVD. Despite this increased risk, intensive treatment reduced the risk of all-cause mortality (HR 0.57, P<0.001) in this subset of SPRINT participants.

Conclusion

Lab based ascertainment of AKI, facilitated by the EHR, may be more sensitive and less biased than traditional SAE reporting, particularly for open-label trials and for capturing more frequent outpatient AKI events. Given that inpatient and outpatient AKI were associated with increased risk for all-cause mortality, identifying ways to prevent AKI may reduce mortality even further with intensive BP lowering.