Kidney Week

Abstract: FR-PO1140

Systolic Blood Pressure Threshold and Clinical Outcomes in Patients with CKD Stage 4/5

Session Information

• CKD: Kidney Function and Extrarenal Complications
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Luo, Jiacong, Davita Clinical Research, Minneapolis, Minnesota, United States

Jiacong Luo, MD, MPH

• Ryan, Claire, Davita Clinical Research, Minneapolis, Minnesota, United States

Claire Ryan, MS

• Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States

Scott Sibbel, PhD

• Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States

Carey Colson

• Marlowe, Gilbert, Davita Clinical Research, Minneapolis, Minnesota, United States

Gilbert Marlowe

• O'Shea, Michael H., DaVita Inc, Denver, Colorado, United States

Michael H. O'Shea, MD

• Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States

Francesca Tentori, MD, MS

• Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli, MD

Background

KDIGO guidelines suggest a systolic blood pressure (SBP) <120 mmHg for chronic kidney disease (CKD) patients. However, there is a paucity of published evidence directly comparing relevant health outcomes across various SBP targets. We investigated the possible impact of various SBP targets on hospitalizations, mortality, and ESKD transitions among CKD stage 4/5 patients.

Methods

We used the Optum® de-identified Integrated Clinical-Claims Dataset that links administrative claims and clinical data from providers across the continuum of care.¹ We selected patients (n=973) with a first diagnosis of CKD 4/5 following 365+ days insurance coverage, who were prescribed 1+ antihypertensive medication. We excluded patients with SBP <110 mmHg to minimize potential confounding from advanced cardiomyopathy. We used the method of recycled predictions to estimate the effect of time updated SBP aligned to guideline targets (separately for <120 and <140 mmHg) on clinical outcomes accounting for clinical confounders.

Results

SBP <140 mmHg was present during 66% of follow up time. Blood pressures in line with this threshold were not differentially associated with rates of mortality or hospitalization; they were associated with a lower rate of ESKD transition (the anticipated change in transition rate is -2.3 transitions per 100 patient years). SBP <120 mmHg was present during 14% of follow up time. Blood pressures in line with this threshold were not differentially associated with rates of mortality or ESKD transition; they were associated with a higher rate of hospitalization (the anticipated average change in admission rates is +22.4 admissions per 100 patient years).

Conclusion

A SBP target of <120 mmHg in patients with CKD is associated with a higher rate of hospitalization without demonstrable benefits. Conversely, a target of <140 mmHg may reduce ESKD transitions without worsening other outcomes. Current guidelines should be reconsidered.

¹ Optum’s de-identified Integrated Claims-Clinical dataset (2007-2021)