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Abstract: PO1792

Markers of Kidney Tubular Secretion and Risk of Cardiovascular Disease and Mortality in Persons with CKD in SPRINT

Session Information

Category: Hypertension and CVD

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

Authors

  • Ascher, Simon, Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Scherzer, Rebecca, Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, United States
  • Bullen, Alexander, University of California San Diego, University of California San Diego, La Jolla, CA, US, academic, La Jolla, California, United States
  • Hallan, Stein I., Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway
  • Jotwani, Vasantha, Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, United States
  • Malhotra, Rakesh, University of California San Diego, University of California San Diego, La Jolla, CA, US, academic, La Jolla, California, United States
  • Estrella, Michelle M., Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, United States
  • Seegmiller, Jesse C., University of Minnesota Academic Health Center, Minneapolis, Minnesota, United States
  • Ix, Joachim H., University of California San Diego, University of California San Diego, La Jolla, CA, US, academic, La Jolla, California, United States
  • Shlipak, Michael, Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, United States
  • Garimella, Pranav S., University of California San Diego, University of California San Diego, La Jolla, CA, US, academic, La Jolla, California, United States
Background

Tubular secretion of organic solutes is essential to the clearance of many drugs, metabolites, and toxins. Whether novel measures of tubular secretion have prognostic value for cardiovascular and mortality risk among hypertensive, nondiabetic persons with CKD is uncertain.

Methods

In 2089 SPRINT (Systolic Blood Pressure Intervention Trial) participants with baseline eGFR <60 ml/min/1.73m2, we created a summary secretion score from 10 tubular secretion biomarkers by averaging across their urine-to-plasma ratios. We used multivariable Cox proportional hazards models to evaluate associations between secretion scores and risk of cardiovascular disease (CVD) and all-cause mortality.

Results

Mean age at baseline was 73 ±9 years and mean eGFR was 46 ±11 ml/min/1.73m2. There were 272 CVD events and 144 deaths during a median follow-up of 3.26 years. In unadjusted analyses, a 1-SD higher secretion score was associated with a lower risk of CVD (hazard ratio [HR] per: 0.87; 95% CI: 0.76, 0.99), but not all-cause mortality (HR: 0.95, 95% CI: 0.80, 1.13) (Table). In multivariable analyses adjusting for baseline eGFR, albuminuria, and CVD risk factors, the association between higher secretion score and CVD risk attenuated and was no longer significant (HR: 0.94, 95% CI: 0.81, 1.08), while higher secretion appeared to be associated with an increased risk of all-cause mortality that did not reach statistical significance (HR: 1.12, 95% CI: 0.95, 1.33).

Conclusion

Among SPRINT participants with CKD, higher tubular secretion was not significantly associated with risk of CVD or mortality after adjustment for eGFR and albuminuria.

Funding

  • NIDDK Support