Key Points

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.

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

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

Conclusions

Overall, and in patients with eGFR

Clinical Trial registry name and registration number:

SPRINT, NCT01206062.