CVD risk in non-albuminuric chronic kidney disease in hypertensive, non-diabetic subjects: A post-hoc analysis from SPRINT

Chang-Sheng Sheng; Dan Wang; Jiangzi Yuan; Yi Cheng; Siming Sun; Yulin Yang; Ya Miao; Weiming Wang; Jingyan Tian; Zachary T Bloomgarden

doi:10.3389/fcvm.2022.977938

CVD risk in non-albuminuric chronic kidney disease in hypertensive, non-diabetic subjects: A post-hoc analysis from SPRINT

Front Cardiovasc Med. 2022 Dec 7:9:977938. doi: 10.3389/fcvm.2022.977938. eCollection 2022.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Ruijin Hospital, Clinical Trial Center, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Renal Division, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵ Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Abstract

Introduction: The risks associated with non-albuminuric chronic kidney disease (CKD) have been investigated in diabetes mellitus but not in hypertensive patients. The objective of this study was to investigate the risks associated with non-albuminuric CKD in treated hypertensive patients in the Systolic Blood Pressure Intervention Trial (SPRINT) population.

Methods: Based on baseline albuminuria status (urine albumin/creatinine ratio [UACR], ≥30 or <30 mg/g) and the levels of estimated glomerular filtration rate ([eGFR], ≥60, 45-59, or <45 mL/min/1.73 m²), participants were classified into six subgroups to assess the risks associated with the primary outcome and mortality. The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or mortality from cardiovascular causes.

Results: During a median follow-up of 3.26 years in 8,866 hypertensive patients, there were 352 deaths and 547 participants with the primary outcome. In adjusted Cox regression analysis using non-CKD and non-albuminuria (eGFR ≥60 mL/min/1.73 m² combined with UACR <30 mg/g) as reference, albuminuria whether combined with CKD or not, showed significantly higher risk of both primary outcome and all-cause mortality in the total population. Whereas, non-albuminuria only combined with eGFR <45 mL/min/1.73 m² showed significantly higher risk of both primary outcome and all-cause mortality in the intensive-therapy group.

Discussion: Non-albuminuric CKD did have higher risk of all-cause and CVD mortality only if the eGFR <45 mL/min/1.73 m². Increased albuminuria conferred higher risk of primary outcome and all-cause mortality irrespective the levels of eGFR.

Clinical trial registration: ClinicalTrials.gov, number: NCT01206062.

Keywords: SPRINT trial; albuminuria; cardiovascular risk factors; chronic kidney disease; hypertension.

Associated data

ClinicalTrials.gov/NCT01206062