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The Legacy Effect of Intensive versus Standard BP Control on the Incidence of Needing Dialysis or Kidney Transplantation
Journal of the American Society of Nephrology ( IF 10.3 ) Pub Date : 2024-07-30 , DOI: 10.1681/asn.0000000000000459
Nicholas M Pajewski 1 , Srinivasan Beddhu 2 , Adam P Bress 3 , Tara I Chang 4 , Glenn M Chertow 4 , Alfred K Cheung 2 , William C Cushman 5 , Barry I Freedman 6 , Tom Greene 3 , Karen C Johnson 5 , Byron C Jaeger 1 , Manjula Kurella Tamura 4, 7 , Cora E Lewis 8 , Mahboob Rahman 9 , David M Reboussin 1 , Michael V Rocco 6 , Jeff D Williamson 10 , Paul K Whelton 11 , Jackson T Wright 8 , Paul E Drawz 12 , Joachim H Ix 13
Affiliation  

gh the differences were not statistically significant. Background 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. Methods 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. Results 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 m2 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 m2 (cause-specific hazard ratio, 1.43; 95% confidence interval, 0.89 to 2.30). Conclusions Overall, and in patients with eGFR <45 ml/min per 1.73 m2, there were higher rates of dialysis or transplantation among SPRINT participants randomized to intensive treatment, but the modest differences observed were not statistically significant. Clinical Trial registry name and registration number: SPRINT, NCT01206062....

中文翻译:


强化血压控制与标准血压控制对需要透析或肾移植发生率的遗留效应



gh 差异无统计学意义。背景 收缩压干预试验 (SPRINT) 显示,强烈降低收缩压会增加 CKD 和 AKI 发作的风险。强化治疗是否会改变肾衰竭的风险尚不清楚。本研究的目的是估计强化收缩压与标准收缩压降低对肾衰竭长期发生率的遗留影响。方法 本研究是对随机、开放标签临床试验的二次分析,并进行了观察性随访。2010 年至 2013 年间,从美国和波多黎各的 102 个诊所招募了 50 岁及以上患有高血压和心血管风险较高的患者,不包括糖尿病、中风病史、蛋白尿 >1 g/d 或多囊肾病患者。参与者被随机分配到收缩压目标为 <120 mm Hg(强化治疗)或 <140 mm Hg(标准治疗组)。我们将参与者与美国肾脏数据系统联系起来,以确定肾衰竭(开始透析治疗或移植),并将参与者与美国国家死亡指数联系起来,以确定到 2020 年的全因死亡率。结果 根据对 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%) 参与者中,基线时 eGFR <45 ml/min 每 1.73 m2。强化治疗总体上(原因特异性风险比,1.20;95% 置信区间,0.81 至 1.78)或基线 eGFR <45 ml/min 每 1.73 m2 的参与者亚组(原因特异性风险比,1.43;95% 置信区间,0.89 至 2.30)。结论 总体而言,在 eGFR <45 ml/min / 1.73 m2 的患者中,随机接受强化治疗的 SPRINT 参与者的透析或移植率较高,但观察到的适度差异没有统计学意义。临床试验注册名称和注册号:SPRINT, NCT01206062....
更新日期:2024-07-30
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