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Acute eGFR declines after intensive BP lowering with RAS blockade and risk of kidney failure

Journal of Human Hypertension volume 35, pages 638–641 (2021)Cite this article

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As guidelines now recommend intensive blood pressure (BP) lowering targets, more patients are being started on intensive BP regimens, which often include renin-angiotensin-aldosterone system (RAS) blockade. Our results suggest that the relation between mild acute estimated glomerular filtration rate (eGFR) declines after starting these regimens and risk of kidney failure was different depending upon BP target intensity, rather than depending upon the inclusion or not of a RAS-blocking agent.

Numerous guidelines regarding blood pressure (BP) management have lowered the recommended targets to <130/80 mmHg for adults following the SPRINT trial, which showed a cardiovascular benefit to more intensive BP lowering [1]. Prior studies have shown that intensive BP lowering or initiation of renin-angiotensin-aldosterone system (RAS) blockade are both frequently associated with mild to moderate acute declines in estimated glomerular filtration rate (eGFR) that are thought to be hemodynamic and benign [2, 3]. Given changes to BP guidelines, increasingly, more patients are being started on both interventions simultaneously (intensive BP lowering with RAS blockade). What has been unclear, however, is whether the risks associated with eGFR declines that occur during BP lowering are different depending on whether RAS-blockade is used. Using data from the African American Study of Kidney Disease and Hypertension (AASK) study, we evaluated the association between acute declines in eGFR and risk of kidney failure (KF) based on the intensity of BP lowering and randomly assigned BP agent.

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References

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Acknowledgements

This work was supported by the National Institutes of Health (K23HL131023 to EK, R01Dk121904 to EK, MJS). The data from the AASK trial and cohort reported here were supplied in part by the NIDDK Central Repositories. This publication was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. The data reported here have been supplied by the United States Renal Data System (USRDS). This manuscript was not prepared in collaboration with investigators of the AASK trial and cohort studies and does not necessarily reflect the opinions or views of the AASK trial and cohort studies, the NIDDK Central Repositories, or the NIDDK grants MD000182, UL1TR000124 and P30AG021684. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH, nor should they be seen as an official policy or interpretation of the US government.

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Authors and Affiliations

  1. Division of Nephrology, Tufts Medical Center, Boston, MA, USA

    Wendy McCallum & Mark J. Sarnak

  2. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Feng Lin

  3. Division of Nephrology and Pediatric Nephrology, University of California San Francisco, San Francisco, CA, USA

    Elaine Ku

Authors
  1. Wendy McCallum
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  2. Mark J. Sarnak
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  3. Feng Lin
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  4. Elaine Ku
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Contributions

Research idea and study design: WM, EK, MJS; statistical analysis: EK, FL; data analysis and interpretation: WM, EK, MJS; supervision and mentorship: EK, MJS.

Corresponding author

Correspondence to Wendy McCallum.

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Financial disclosures

MJS reports membership on the steering committee of trials funded by Akebia with funds paid to Tufts Medical Center; serving as consultant for Cardurian, which is developing potential treatments for heart failure; and having attended an advisory board for Bayer within the past 2 years.

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The authors declare that they have no conflict of interest.

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McCallum, W., Sarnak, M.J., Lin, F. et al. Acute eGFR declines after intensive BP lowering with RAS blockade and risk of kidney failure. J Hum Hypertens 35, 638–641 (2021). https://doi.org/10.1038/s41371-021-00487-7

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  • DOI: https://doi.org/10.1038/s41371-021-00487-7

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