Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota.
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Clin J Am Soc Nephrol. 2024 Feb 1;19(2):213-223. doi: 10.2215/CJN.0000000000000335. Epub 2023 Oct 25.
Intensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values.
SPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m 2 and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m 2 , respectively.
EHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m 2 per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m 2 per year (95% CI, -1.08 to -0.85) in the intensive treatment group ( P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m 2 per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m 2 per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70).
Intensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.
强化降压治疗在收缩压干预试验（SPRINT）中导致肾功能急性下降，并增加急性肾损伤（AKI）风险。我们通过使用试验和门诊电子健康记录（EHR）肌酐值评估强化降压治疗对长期肾功能变化的影响。
SPRINT 数据与来自 49 个（102 个中的 49 个）研究站点的 EHR 数据相链接。主要结局是干预阶段 eGFR 下降的总斜率，以及观察阶段使用试验和门诊 EHR 值的 eGFR 下降的后试验斜率。次要结局包括 eGFR 下降≥30%至<60ml/min/1.73m2，以及基线 eGFR≥60且<60ml/min/1.73m2的参与者中 eGFR 下降≥50%或发生终末期肾病。
对于 3041 名参与者，EHR 肌酐值中位数可获得 8.3 年。在标准治疗组中，干预阶段 eGFR 下降的总斜率为每年-0.67ml/min/1.73m2（95%置信区间[CI]：-0.79 至-0.56），在强化治疗组中为每年-0.96ml/min/1.73m2（95%CI：-1.08 至-0.85）（P<0.001）。在观察阶段，斜率无显著差异：标准组每年-1.02ml/min/1.73m2（95%CI：-1.24 至-0.81），强化组每年-0.85ml/min/1.73m2（95%CI：-1.07 至-0.64）。在基线时无 CKD 的参与者中，强化治疗与干预期间 eGFR 下降≥30%的风险增加相关（风险比，3.27；95%CI：2.43 至 4.40），但与干预后观察阶段无关。在基线时患有 CKD 的参与者中，强化治疗仅与干预阶段 eGFR 下降的风险增加相关（风险比，1.95；95%CI：1.03 至 3.70）。
强化降压治疗与试验干预阶段 eGFR 下降总斜率更陡峭和肾脏事件风险增加相关，但与干预后观察阶段无关。
