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Public Release Type:
Journal
Publication Year: 2023
Affiliation:
1 Departments of Medicine and Pediatrics, Divisions of Nephrology, University of California San Francisco
2 Department of Epidemiology and Biostatistics, University of California San Francisco
3 Department of Medicine, Division of Nephrology, Tufts University
4 Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Germany
5 Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Ranica, Bergamo, Italy
6 Unit of Nephrology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
Request IDs:
4528
Studies:
African American Study of Kidney Disease and Hypertension Cohort Study
,
African American Study of Kidney Disease and Hypertension Study (Clinical Trial)
,
Modification of Diet in Renal Disease
Background: The effect of intensive blood pressure (BP) lowering on the risk of kidney replacement therapy (KRT) remains unclear in patients with advanced kidney disease who were not well-represented in trials evaluating intensive BP control. Methods: We pooled individual-level data from seven trials that included patients with eGFR<60 mL/min/1.73 m2 to examine the effect of intensive BP lowering on the risk of KRT, or when not possible, trial-defined kidney outcomes. We performed pre-specified subgroup analyses to evaluate the effect of intensive BP control by baseline albuminuria and eGFR (CKD stage 4-5 versus 3). Results: We included 5823 trial participants, of whom 526 developed the kidney outcome and 382 died. Overall, intensive (versus usual) BP control was associated with a lower risk of the kidney outcome (HR 0.87 [95% CI 0.74-1.04]) and death (HR 0.87 [95% CI 0.71-1.06]) in unadjusted analysis which did not achieve statistical significance. However, there was heterogeneity in the effect of the intervention on the kidney outcome by baseline GFR (pinteraction=0.05). By intention to treat, intensive (versus usual) BP control was associated with lower risk of the primary kidney outcome in those with CKD GFR stage 4-5 (HR 0.80 [95% CI 0.65-0.98]) but not in CKD GFR stage 3 (HR 1.08 [95% CI 0.79-1.48]). There was no interaction between intensive BP control and severity of albuminuria for kidney outcomes (p=0.32). Conclusion: In patients with CKD, intensive BP control was associated with a reduction in the risk of kidney outcomes, especially in the setting of stage 4-5 disease. These findings suggest the safety of and need to conduct future trials of BP targets focused on populations with advanced kidney disease.
