Kidney Week

Abstract: FR-OR040

Individualized Net Benefit of Intensive Blood Pressure Lowering Among Persons with CKD in SPRINT

Session Information

• Hypertension and Cardiorenal Disease: Novel Mechanisms and Therapeutic Targets
  November 07, 2025 | Location: Room 332A, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Vera, Alan R, University of California Davis, Sacramento, California, United States

Alan R Vera

• Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States

Rebecca Scherzer, PhD

• Kravitz, Richard L, University of California Davis, Sacramento, California, United States

Richard L Kravitz, MD, MS

• Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States

Michelle M. Estrella, MD, MHS

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix, MD, FASN

• Shlipak, Michael, University of California San Francisco, San Francisco, California, United States

Michael Shlipak, MD, MPH

• Ascher, Simon, University of California Davis, Sacramento, California, United States

Simon Ascher, MD, MPH

Background

Optimal BP targets for adults with hypertension and CKD remain controversial. We used predicted risks and simulated preferences to estimate the individualized net benefit of intensive BP lowering among persons with CKD in the Systolic Blood Pressure Intervention Trial (SPRINT).

Methods

Among 2012 participants with CKD at baseline (eGFR <60 mL/min/1.73m² at baseline) , Cox models were used to predict an absolute difference in risk between treating to a systolic BP target of <120 vs <140 mm Hg for all-cause death, cardiovascular outcomes, cognitive outcomes, and BP treatment-related harms. We calculated the individualized net benefit for each participant as the weighted sum of risk differences using literature-based preference weights to calibrate the relative importance of each potential outcome. Sensitivity analyses applied alternative preference weights that reflect benefits and harms as having similar importance. Net benefits were compared by baseline eGFR category, ≥45 vs <45 ml/min/1.73m².

Results

Mean age was 73 ±9 y; 43% were female; 31% were Black, and eGFR and albuminuria at baseline were 46 ±11 ml/min/1.73m² and 16 (IQR: 7, 56) mg/g, respectively. In the primary analysis, when simulating preferences for participants who view the benefits of intensive BP lowering (reduction in death, cardiovascular events, and cognitive impairment) as much more important than treatment-related harms (e.g., acute kidney injury and syncope), the median net benefit was 6.4% and 100% had a net benefit favoring intensive BP lowering. In the sensitivity analysis, when simulating benefits and harms to have similar importance, the median net benefit was 2.2% and 90% had a positive net benefit. Compared with participants with baseline eGFR ≥45 ml/min/1.73m², those with eGFR <45 ml/min/1.73m² had greater net benefits from intensive BP lowering in both preference scenarios (P <0.001 for both comparisons; Table 1).

Conclusion

Almost all SPRINT participants with CKD had a net benefit that favored a systolic BP target of <120 mm Hg. The magnitude of net benefit was stronger among those with more advanced CKD.

Funding

• Other NIH Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20259y3vaxb9