AKI Risk Elevated by Intensive Blood Pressure Lowering

Intensive blood pressure (BP) lowering is associated with more frequent episodes of acute kidney injury (AKI), according to the results of a recent study.

While previous research has suggested that intense BP lowering could help to lower rates of cardiovascular disease, its effects on the risk of AKI are not known.
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The researchers conducted a study involving  9361 participants aged 50 years or older who had 1 or more risk factors for cardiovascular disease. The participants were randomly assigned to either a systolic BP target of <120 (intensive arm) or <140 mm Hg (standard arm).

Overall, 179 participants experienced AKI events in the intensive arm, while 109 experienced AKI in the standard arm (3.8% vs 2.3%; HR, 1.64; 95% CI, 1.30-2.10; P < 0.001). The number of AKI events in the intensive vs standard arms divided by Kidney Disease: Improving Global Outcomes (KDIGO) stage was 128 (58.5%) versus 81 (62.8%) for AKI stage 1, 42 (19.2%) versus 18 (14.0%) for AKI stage 2, and 42 (19.2%) versus 25 (19.4%) for AKI stage 3 (P = 0.5). Complete or partial resolution of AKI was observed in 169 and 9 participants in the intensive arm and 86 and 4 participants in the standard arm, respectively.

“More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function,” the researchers concluded.

—Michael Potts

Reference:

Rocco MV, Sink KM, Lovato LC, et al. Effects of intensive blood pressure treatment on acute kidney injury events in the systolic blood pressure intervention trial (SPRINT). AJKD. 2018;71(3):352-361.