Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT)

SPRINT Research Group

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. Study Design: Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease. Interventions: Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140 mm Hg (standard arm). Outcomes & Measurements: Primary outcome was the number of adjudicated AKI events. Secondary outcomes included severity of AKI and degree of recovery of kidney function after an AKI event. Baseline creatinine concentration was defined as the most recent SPRINT outpatient creatinine value before the date of the AKI event. Results: There were 179 participants with AKI events in the intensive arm and 109 in the standard arm (3.8% vs 2.3%; HR, 1.64; 95% CI, 1.30-2.10; P < 0.001). Of 288 participants with an AKI event, 248 (86.1%) had a single AKI event during the trial. Based on modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria for severity of AKI, the number of AKI events in the intensive versus standard arm by KDIGO stage was 128 (58.5%) versus 81 (62.8%) for AKI stage 1, 42 (19.2%) versus 18 (14.0%) for AKI stage 2, and 42 (19.2%) versus 25 (19.4%) for AKI stage 3 (P = 0.5). For participants with sufficient data, complete or partial resolution of AKI was seen for 169 (90.4%) and 9 (4.8%) of 187 AKI events in the intensive arm and 86 (86.9%) and 4 (4.0%) of 99 AKI events in the standard arm, respectively. Limitations: Trial results are not generalizable to patients with diabetes mellitus or without risk factors for cardiovascular disease. Conclusions: More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function. Trial Registration: Registered at ClinicalTrials.gov with study number NCT01206062.

Original languageEnglish (US)
Pages (from-to)352-361
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume71
Issue number3
DOIs
StatePublished - Mar 1 2018

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Acute Kidney Injury
Blood Pressure
Therapeutics
Recovery of Function
Kidney Diseases
Creatinine
Cardiovascular Diseases
Kidney

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT). / SPRINT Research Group.

In: American Journal of Kidney Diseases, Vol. 71, No. 3, 01.03.2018, p. 352-361.

Research output: Contribution to journalArticle

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title = "Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT)",
abstract = "Background: Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. Study Design: Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease. Interventions: Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140 mm Hg (standard arm). Outcomes & Measurements: Primary outcome was the number of adjudicated AKI events. Secondary outcomes included severity of AKI and degree of recovery of kidney function after an AKI event. Baseline creatinine concentration was defined as the most recent SPRINT outpatient creatinine value before the date of the AKI event. Results: There were 179 participants with AKI events in the intensive arm and 109 in the standard arm (3.8{\%} vs 2.3{\%}; HR, 1.64; 95{\%} CI, 1.30-2.10; P < 0.001). Of 288 participants with an AKI event, 248 (86.1{\%}) had a single AKI event during the trial. Based on modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria for severity of AKI, the number of AKI events in the intensive versus standard arm by KDIGO stage was 128 (58.5{\%}) versus 81 (62.8{\%}) for AKI stage 1, 42 (19.2{\%}) versus 18 (14.0{\%}) for AKI stage 2, and 42 (19.2{\%}) versus 25 (19.4{\%}) for AKI stage 3 (P = 0.5). For participants with sufficient data, complete or partial resolution of AKI was seen for 169 (90.4{\%}) and 9 (4.8{\%}) of 187 AKI events in the intensive arm and 86 (86.9{\%}) and 4 (4.0{\%}) of 99 AKI events in the standard arm, respectively. Limitations: Trial results are not generalizable to patients with diabetes mellitus or without risk factors for cardiovascular disease. Conclusions: More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function. Trial Registration: Registered at ClinicalTrials.gov with study number NCT01206062.",
author = "{SPRINT Research Group} and Rocco, {Michael V.} and Sink, {Kaycee M.} and Lovato, {Laura C.} and Wolfgram, {Dawn F.} and Wiegmann, {Thomas B.} and Barry Wall and Kausik Umanath and Frederic Rahbari-Oskoui and Porter, {Anna C.} and Roberto Pisoni and Lewis, {Cora E.} and Lewis, {Julia B.} and Lash, {James P.} and Katz, {Lois A.} and Hawfield, {Amret T.} and Haley, {William E.} and Freedman, {Barry I.} and Dwyer, {Jamie P.} and Drawz, {Paul E.} and Mirela Dobre and Cheung, {Alfred K.} and Campbell, {Ruth C.} and Udayan Bhatt and Srinivasan Beddhu and Kimmel, {Paul L.} and Reboussin, {David M.} and Chertow, {Glenn M.}",
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T1 - Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT)

AU - SPRINT Research Group

AU - Rocco, Michael V.

AU - Sink, Kaycee M.

AU - Lovato, Laura C.

AU - Wolfgram, Dawn F.

AU - Wiegmann, Thomas B.

AU - Wall, Barry

AU - Umanath, Kausik

AU - Rahbari-Oskoui, Frederic

AU - Porter, Anna C.

AU - Pisoni, Roberto

AU - Lewis, Cora E.

AU - Lewis, Julia B.

AU - Lash, James P.

AU - Katz, Lois A.

AU - Hawfield, Amret T.

AU - Haley, William E.

AU - Freedman, Barry I.

AU - Dwyer, Jamie P.

AU - Drawz, Paul E.

AU - Dobre, Mirela

AU - Cheung, Alfred K.

AU - Campbell, Ruth C.

AU - Bhatt, Udayan

AU - Beddhu, Srinivasan

AU - Kimmel, Paul L.

AU - Reboussin, David M.

AU - Chertow, Glenn M.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. Study Design: Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease. Interventions: Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140 mm Hg (standard arm). Outcomes & Measurements: Primary outcome was the number of adjudicated AKI events. Secondary outcomes included severity of AKI and degree of recovery of kidney function after an AKI event. Baseline creatinine concentration was defined as the most recent SPRINT outpatient creatinine value before the date of the AKI event. Results: There were 179 participants with AKI events in the intensive arm and 109 in the standard arm (3.8% vs 2.3%; HR, 1.64; 95% CI, 1.30-2.10; P < 0.001). Of 288 participants with an AKI event, 248 (86.1%) had a single AKI event during the trial. Based on modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria for severity of AKI, the number of AKI events in the intensive versus standard arm by KDIGO stage was 128 (58.5%) versus 81 (62.8%) for AKI stage 1, 42 (19.2%) versus 18 (14.0%) for AKI stage 2, and 42 (19.2%) versus 25 (19.4%) for AKI stage 3 (P = 0.5). For participants with sufficient data, complete or partial resolution of AKI was seen for 169 (90.4%) and 9 (4.8%) of 187 AKI events in the intensive arm and 86 (86.9%) and 4 (4.0%) of 99 AKI events in the standard arm, respectively. Limitations: Trial results are not generalizable to patients with diabetes mellitus or without risk factors for cardiovascular disease. Conclusions: More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function. Trial Registration: Registered at ClinicalTrials.gov with study number NCT01206062.

AB - Background: Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. Study Design: Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT). Setting & Participants: 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease. Interventions: Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140 mm Hg (standard arm). Outcomes & Measurements: Primary outcome was the number of adjudicated AKI events. Secondary outcomes included severity of AKI and degree of recovery of kidney function after an AKI event. Baseline creatinine concentration was defined as the most recent SPRINT outpatient creatinine value before the date of the AKI event. Results: There were 179 participants with AKI events in the intensive arm and 109 in the standard arm (3.8% vs 2.3%; HR, 1.64; 95% CI, 1.30-2.10; P < 0.001). Of 288 participants with an AKI event, 248 (86.1%) had a single AKI event during the trial. Based on modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria for severity of AKI, the number of AKI events in the intensive versus standard arm by KDIGO stage was 128 (58.5%) versus 81 (62.8%) for AKI stage 1, 42 (19.2%) versus 18 (14.0%) for AKI stage 2, and 42 (19.2%) versus 25 (19.4%) for AKI stage 3 (P = 0.5). For participants with sufficient data, complete or partial resolution of AKI was seen for 169 (90.4%) and 9 (4.8%) of 187 AKI events in the intensive arm and 86 (86.9%) and 4 (4.0%) of 99 AKI events in the standard arm, respectively. Limitations: Trial results are not generalizable to patients with diabetes mellitus or without risk factors for cardiovascular disease. Conclusions: More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function. Trial Registration: Registered at ClinicalTrials.gov with study number NCT01206062.

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DO - 10.1053/j.ajkd.2017.08.021

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EP - 361

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

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