Intensive blood pressure control to a systolic blood pressure less than 120 mm Hg may reduce the risk of kidney replacement therapy (KRT) in patients with advanced chronic kidney disease (CKD), a new study suggests.

In a post hoc analysis, investigators pooled data from 7 trials testing intensive vs usual blood pressure control in 5823 adult and pediatric patients with an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Approximately 43% of patients were from SPRINT, 8.6% from ACCORD, 14.1% from MDRD, 16.5% from AASK, 7.0% from SPS3 trial, 5.6% from ESCAPE, and 5.3% from REIN-2.

Of the 5823 patients, 1089 (22%) had stage 4-5 CKD and 4744 had stage 3 CKD. In adjusted subgroup analyses, intensive vs usual blood pressure control was significantly associated with a 19% decreased risk of kidney failure requiring KRT in patients with eGFR-based stage 4-5 CKD, Elaine Ku, MD, MAS, of the University of California, San Francisco, and colleagues reported in the Journal of the American Society of Nephrology. Patients with stage 3 CKD did not experience a benefit. Only 8.6% of the population had a history of diabetes, which is a study limitation. Albuminuria was not associated with the kidney outcome.

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The latest Kidney Disease Improving Global Outcomes (KDIGO) blood pressure guidelines recommend treating all patients with CKD to a target systolic blood pressure less than 120 mmHg using standardized blood pressure measurements. Patients with stage 4-5 CKD were underrepresented in the evidence base for the guidelines, however.

“Although our analyses are post-hoc, there is no evidence of harm in this high-risk population from either the kidney or the mortality standpoint,” Dr Ku’s team wrote. “However, we acknowledge that these data require further confirmation in adequately powered clinical trials.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Ku E, McCulloch CE, Inker LA, et al. Intensive BP control in patients with CKD and risk for adverse outcomes. J Am Soc Nephrol. Published online January 17, 2023. doi:10.1681/ASN.0000000000000072