Intensive blood pressure control to a systolic blood pressure less than 120 mm Hg may reduce the risk of kidney replacement therapy (KRT) in patients with advanced chronic kidney disease (CKD), a new study suggests.
In a post hoc analysis, investigators pooled data from 7 trials testing intensive vs usual blood pressure control in 5823 adult and pediatric patients with an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Approximately 43% of patients were from SPRINT, 8.6% from ACCORD, 14.1% from MDRD, 16.5% from AASK, 7.0% from SPS3 trial, 5.6% from ESCAPE, and 5.3% from REIN-2.
Of the 5823 patients, 1089 (22%) had stage 4-5 CKD and 4744 had stage 3 CKD. In adjusted subgroup analyses, intensive vs usual blood pressure control was significantly associated with a 19% decreased risk of kidney failure requiring KRT in patients with eGFR-based stage 4-5 CKD, Elaine Ku, MD, MAS, of the University of California, San Francisco, and colleagues reported in the Journal of the American Society of Nephrology. Patients with stage 3 CKD did not experience a benefit. Only 8.6% of the population had a history of diabetes, which is a study limitation. Albuminuria was not associated with the kidney outcome.
The latest Kidney Disease Improving Global Outcomes (KDIGO) blood pressure guidelines recommend treating all patients with CKD to a target systolic blood pressure less than 120 mmHg using standardized blood pressure measurements. Patients with stage 4-5 CKD were underrepresented in the evidence base for the guidelines, however.
“Although our analyses are post-hoc, there is no evidence of harm in this high-risk population from either the kidney or the mortality standpoint,” Dr Ku’s team wrote. “However, we acknowledge that these data require further confirmation in adequately powered clinical trials.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Renal and Urology News
Ku E, McCulloch CE, Inker LA, et al. Intensive BP control in patients with CKD and risk for adverse outcomes. J Am Soc Nephrol. Published online January 17, 2023. doi:10.1681/ASN.0000000000000072