Pajewski Nicholas M, Beddhu Srinivasan, Bress Adam P, Chang Tara I, Chertow Glenn M, Cheung Alfred K, Cushman William C, Freedman Barry I, Greene Tom, Johnson Karen C, Jaeger Byron C, Tamura Manjula Kurella, Lewis Cora E, Rahman Mahboob, Reboussin David M, Rocco Michael V, Williamson Jeff D, Whelton Paul K, Wright Jackson T, Drawz Paul E, Ix Joachim H
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
J Am Soc Nephrol. 2024 Dec 1;35(12):1737-1745. doi: 10.1681/ASN.0000000000000459. Epub 2024 Jul 30.
In the Systolic Blood Pressure Intervention Trial (SPRINT), the longer-term incidence of needing dialysis or transplantation was low and primarily associated with baseline kidney function. Rates of dialysis or transplantation were higher with intensive versus standard treatment, though the differences were not statistically significant.
The Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive lowering of systolic BP increased the risk of incident CKD and episodes of AKI. Whether intensive treatment changes the risk of kidney failure is unknown. The goal of this study was to estimate the legacy effect of intensive versus standard systolic BP lowering on the longer-term incidence of kidney failure.
This study is a secondary analysis of a randomized, open-label clinical trial with observational follow-up. Between 2010 and 2013, patients 50 years and older with hypertension and higher cardiovascular risk excluding those with diabetes mellitus, history of stroke, proteinuria >1 g/d, or polycystic kidney disease were recruited from 102 clinic sites in the United States and Puerto Rico. Participants were randomized to a systolic BP goal of <120 mm Hg (intensive treatment) or <140 mm Hg (standard treatment group). We linked participants with the United States Renal Data System to ascertain kidney failure (initiation of dialysis therapy or transplantation) and the US National Death Index to ascertain all-cause mortality through 2020.
Based on analysis of 9279 (99.1%) of 9361 randomized participants, 101 cases of kidney failure occurred over a median follow-up of 8.6 years (interquartile range, 8.0–9.1 years), with the majority occurring in 74 (73.3%) participants with an eGFR <45 ml/min per 1.73 m at baseline. Intensive treatment did not significantly increase the risk of kidney failure either overall (cause-specific hazard ratio, 1.20; 95% confidence interval, 0.81 to 1.78) or in the subgroup of participants with baseline eGFR <45 ml/min per 1.73 m (cause-specific hazard ratio, 1.43; 95% confidence interval, 0.89 to 2.30).
Overall, and in patients with eGFR <45 ml/min per 1.73 m, there were higher rates of dialysis or transplantation among SPRINT participants randomized to intensive treatment, but the modest differences observed were not statistically significant.
: SPRINT, NCT01206062.
在收缩压干预试验（SPRINT）中，需要透析或移植的长期发生率较低，且主要与基线肾功能相关。强化治疗组与标准治疗组相比，透析或移植率更高，不过差异无统计学意义。
收缩压干预试验（SPRINT）表明，强化降低收缩压会增加新发慢性肾脏病和急性肾损伤发作的风险。强化治疗是否会改变肾衰竭风险尚不清楚。本研究的目的是评估强化与标准收缩压降低对肾衰竭长期发生率的遗留效应。
本研究是一项随机、开放标签的临床试验的二次分析，并进行观察性随访。2010年至2013年期间，从美国和波多黎各的102个临床地点招募了年龄在50岁及以上、患有高血压且心血管风险较高的患者，排除患有糖尿病、中风病史、蛋白尿>1 g/d或多囊肾病的患者。参与者被随机分为收缩压目标<120 mmHg（强化治疗）或<140 mmHg（标准治疗组）。我们将参与者与美国肾脏数据系统关联以确定肾衰竭（开始透析治疗或移植），并与美国国家死亡指数关联以确定截至2020年的全因死亡率。
基于对9361名随机参与者中的9279名（99.1%）的分析，在中位随访8.6年（四分位间距，8.0 - 9.1年）期间发生了101例肾衰竭，其中大多数发生在74名（73.3%）基线估算肾小球滤过率（eGFR）<45 ml/（min·1.73 m²）的参与者中。强化治疗总体上（病因特异性风险比，1.20；95%置信区间[CI]，0.81至1.78）或在基线eGFR<45 ml/（min·1.73 m²）的参与者亚组中（病因特异性风险比，1.43；95%CI，0.89至2.30）均未显著增加肾衰竭风险。
总体而言，在估算肾小球滤过率（eGFR）<45 ml/（min·1.73 m²）的患者中，SPRINT试验中随机接受强化治疗的参与者的透析或移植率较高，但观察到的适度差异无统计学意义。
SPRINT，NCT01206062 。
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