SPRINT Treatment Among Adults With Chronic Kidney Disease From 2 Large Health Care Systems

Area of Science:

• Nephrology
• Cardiology
• Clinical Trials

Background:

• Clinical trials on intensive vs. standard blood pressure (BP) targets may not generalize to chronic kidney disease (CKD) patients in routine practice.
• Differences in cardiovascular risk factors and comorbidities can affect treatment outcomes in CKD populations.

Purpose of the Study:

• To assess if the effects of intensive vs. standard BP control from the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to adult CKD patients in clinical practice.
• To evaluate the transportability of SPRINT's findings on beneficial and adverse effects to a real-world CKD population.

Main Methods:

• A comparative effectiveness study using data from the Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC) for CKD patients meeting SPRINT eligibility criteria.
• Combined SPRINT data with VHA and KPSC covariate data to estimate treatment effects in the target populations using outcome distribution models.

Main Results:

• Patients in VHA and KPSC were older, had less prevalent cardiovascular disease, higher albuminuria, and used more statins compared to SPRINT participants.
• Intensive BP control was associated with transportable reductions in major cardiovascular events and all-cause death, but not consistently for cognitive or CKD outcomes.
• Intensive BP treatment showed lower absolute risks for major cardiovascular events (3.0-5.1%) and higher risks for adverse events (1.3-3.1%) in VHA and KPSC populations.

Conclusions:

• The reduction in cardiovascular events and increase in adverse events observed in SPRINT were largely transferable to CKD populations in clinical practice.
• Implementing intensive BP targets may offer benefits for cardiovascular outcomes in CKD patients.
• The study highlights the need to consider population differences when extrapolating clinical trial results to real-world settings.