Kidney Week

Abstract: FR-OR51

Outcomes of Real-World Adults with CKD Who Are Not Represented in Blood Pressure Target Trials

Session Information

• Hypertension, CVD, and the Kidneys: Clinical Studies
  October 25, 2024 | Location: Room 5, Convention Center
  Abstract Time: 05:20 PM - 05:30 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Li, June, Stanford University School of Medicine, Stanford, California, United States

June Li, MS

• An, Jaejin, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, United States

Jaejin An, PhD

• Zhou, Matt Mengnan, Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, California, United States

Matt Mengnan Zhou

• Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States

Maria E. Montez-Rath, PhD

• Huang, Mengjiao, VA Palo Alto Geriatric Research Education and Clinical Center, Palo Alto, California, United States

Mengjiao Huang, PhD

• Niu, Fang, Kaiser Permanente Southern California, Pasadena, California, United States

Fang Niu, MS

• Sim, John J., Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States

John J. Sim, MD, FASN

• Odden, Michelle, Stanford University School of Medicine, Stanford, California, United States

Michelle Odden, PhD

• Charu, Vivek, Stanford University School of Medicine, Stanford, California, United States

Vivek Charu, MD, PhD

• Kurella Tamura, Manjula, VA Palo Alto Geriatric Research Education and Clinical Center, Palo Alto, California, United States

Manjula Kurella Tamura, MD, MPH

Background

Blood pressure (BP) target trials often include adults with chronic kidney disease (CKD) who are healthier and have less chronic conditions compared to their real-world counterparts. We assessed whether clinical outcomes differed between trial eligible and ineligible adults with CKD.

Methods

We identified adults with CKD and hypertension in the Veterans Health Administration (VA) and Kaiser Permanente Southern California (KPSC) in 2019 who met eligibility for one of three BP target trials, SPRINT, ACCORD, and AASK. We compared the relative and absolute risks of death, major cardiovascular events (MACE), serious adverse events (SAEs), and end stage kidney disease (ESKD) between trial eligible and ineligible adults. Patients were followed until an outcome or up to September 30, 2022.

Results

We identified 503,480 adults in the VA (76.1% ineligible) and 73,412 adults in KPSC (79.2% ineligible) with CKD and hypertension. Compared to trial eligible adults, trial ineligible adults had a moderately elevated risk of death, MACE, and SAEs (Hazard ratio (HR) ranges, VA: 1.43-4.17; KPSC: 1.11-3.60), and a markedly elevated risk of ESKD (HR ranges, VA: 4.08-6.22; KPSC: 5.93-8.38). The corresponding absolute risk differences (RD, per 1000 person-years) were largest for death, MACE, and kidney related SAEs (RD ranges, VA: 3.6-17.4; KPSC: 4.5-16.1), and smallest for ESKD (RD ranges, VA: 0.4-4.3; KPSC: 0.8-13.2). Adults ineligible due to diabetes or end-organ damage had the highest relative and absolute risks in outcomes.

Conclusion

Trial ineligible adults with CKD and hypertension have higher risks for death, MACE, ESKD and SAEs compared to trial eligible adults, but the pattern of risk differed by outcome. The benefit-risk profile of hypertension treatment in the real-world population may differ from that of adults with CKD included in trials.

Figure. HR and RD for outcomes in trial eligible vs. ineligible adults in the VA and KPSC.

Funding

• NIDDK Support