Kidney Week

Abstract: TH-PO0301

Heterogenous Treatment Effects of Intensive vs. Standard Blood Pressure Control on eGFR Slope in Patients with CKD

Session Information

• Hypertension and CVD: Clinical - 1
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Li, June, Stanford University School of Medicine, Stanford, California, United States

June Li, MS

• Kurella Tamura, Manjula, VA Palo Alto Geriatric Research Education and Clinical Center, Palo Alto, California, United States

Manjula Kurella Tamura, MD, MPH

• Charu, Vivek, Stanford University School of Medicine, Stanford, California, United States

Vivek Charu, MD, PhD

Background

We assessed the effect of intensive versus standard BP control on estimated glomerular filtration rate (eGFR) slope in patients with hypertension and CKD and examined whether effects varied by baseline eGFR and albuminuria.

Methods

We identified patients with eGFR < 60 ml/min/1.73m2 from 5 BP trials: SPRINT, ACCORD, AASK, MDRD, and SPS3. For each trial, we used shared parameter models that jointly models eGFR trajectories and informative censoring to estimate the 3-year total slope. We calculated the mean difference in eGFR slope between intensive and standard arms. We stratified the analysis by baseline eGFR and albuminuria in each study.

Results

There were 2260, 476, 1098, 840, and 339 participants with CKD in SPRINT, ACCORD, AASK, MDRD, and SPS3 respectively. SPRINT and ACCORD showed evidence of faster eGFR slope decline in the intensive v. standard BP control. We found weak evidence for heterogeneity in treatment effects of intensive BP control on eGFR slope; intensive BP control slowed eGFR decline in participants with eGFR <30 (mean difference range: 0.17-0.71 ml/min/1.73m²), while it accelerated eGFR decline in patients with eGFR 30 to 59 (range: -1.56–0.59 ml/min/1.73m²). Similarly, among participants with severely increased baseline albuminuria, intensive BP control was associated with slower eGFR decline (range: 0.47-1.63 ml/min/1.73m²), but this effect was not observed in patients with normal to moderately increased albuminuria (range: -2.35-0.15 ml/min/1.73m²). Importantly, confidence intervals for subgroup effects were large and often overlapping.

Conclusion

Intensive BP control may be beneficial for slowing eGFR decline in patients with eGFR <30 and in patients with severe albuminuria.

eGFR slope difference between the intensive and standard BP arms in trial CKD patients overall and by eGFR and albuminuria.

Funding

• Other NIH Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025tryh47yq