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Acute Declines in Renal Function during Intensive BP Lowering: Implications for Future ESRD Risk.

Elaine Ku1,2, George Bakris3, Kirsten L Johansen4

  • 1Division of Nephrology, Department of Medicine, elaine.ku@ucsf.edu.

Journal of the American Society of Nephrology : JASN
|May 6, 2017
PubMed
Summary

Acute kidney function decline of 20% or more during intensive blood pressure lowering increases end-stage renal disease risk. Moderate declines (5-20%) did not raise risk in intensive lowering but did in usual care, indicating safety of stricter BP control.

Keywords:
ESRDchronic kidney diseasehypertension

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Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • The acceptable level of renal function decline during intensive blood pressure (BP) management is not well-defined.
  • Understanding the association between acute kidney function changes and end-stage renal disease (ESRD) risk is crucial for managing chronic kidney disease (CKD).

Purpose of the Study:

  • To investigate if acute declines in estimated glomerular filtration rate (eGFR) during intensive BP lowering in CKD patients are linked to an increased risk of ESRD.
  • To compare the risk of ESRD associated with varying degrees of eGFR decline under strict versus usual BP control strategies.

Main Methods:

  • Retrospective analysis of 899 participants from the African American Study of Kidney Disease and Hypertension (AASK) and 761 from the Modification of Diet in Renal Disease (MDRD) Trial.
  • Patients were categorized by percentage decline in eGFR (<5%, 5% to <20%, or ≥20%) between randomization and months 3-4.
  • ESRD incidence was the primary outcome, analyzed in relation to BP control intensity (strict vs. usual).

Main Results:

  • A 5% to <20% eGFR decline during intensive BP lowering was not associated with higher ESRD risk in either AASK or MDRD Trial.
  • Conversely, a 5% to <20% eGFR decline in the usual BP arm was linked to increased ESRD risk in both trials.
  • An eGFR decline of ≥20% was associated with a higher risk of ESRD under both strict and usual BP control regimens.

Conclusions:

  • Acute eGFR declines of 20% or more during intensive BP lowering identify patients at significantly higher risk for adverse renal outcomes.
  • Moderate eGFR declines (5% to <20%) during intensive BP lowering appear safe and do not increase ESRD risk, supporting the benefits of strict BP control.