TY - JOUR
T1 - Estimated GFR Variability and Risk of Cardiovascular Events and Mortality in SPRINT (Systolic Blood Pressure Intervention Trial)
AU - Malhotra, Rakesh
AU - Katz, Ronit
AU - Jotwani, Vasantha
AU - Agarwal, Adhish
AU - Cohen, Debbie L.
AU - Cushman, William C.
AU - Ishani, Areef
AU - Killeen, Anthony A.
AU - Kitzman, Dalane W.
AU - Oparil, Suzanne
AU - Papademetriou, Vasilios
AU - Parikh, Chirag R.
AU - Raphael, Kalani L.
AU - Rocco, Michael V.
AU - Tamariz, Leonardo J.
AU - Whelton, Paul K.
AU - Wright, Jackson T.
AU - Shlipak, Michael G.
AU - Ix, Joachim H.
N1 - Publisher Copyright:
© 2020
PY - 2021/7
Y1 - 2021/7
N2 - Rationale and Objective: Although low estimated glomerular filtration rate (eGFR) is associated with cardiovascular disease (CVD) events and mortality, the clinical significance of variability in eGFR over time is uncertain. This study aimed to evaluate the associations between variability in eGFR and the risk of CVD events and all-cause mortality. Study Design: Longitudinal analysis of clinical trial participants. Settings and Participants: 7,520 Systolic Blood Pressure Intervention Trial (SPRINT) participants ≥50 year of age with 1 or more CVD risk factors. Predictors: eGFR variability, estimated by the coefficient of variation of eGFR assessments at the 6th, 12th, and 18-month study visits. Outcomes: The SPRINT primary CVD composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and all-cause mortality from month 18 to the end of follow-up. Analytical Approach: Cox models were used to evaluate associations between eGFR variability and CVD outcomes and all-cause mortality. Models were adjusted for demographics, randomization arm, CVD risk factors, albuminuria, and eGFR at month 18. Results: Mean age was 68 ± 9 years; 65% were men; and 58% were White. The mean eGFR was 73 ± 21 (SD) mL/min/1.73 m2 at 6 months. There were 370 CVD events and 154 deaths during a median follow-up of 2.4 years. Greater eGFR variability was associated with higher risk for all-cause mortality (hazard ratio [HR] per 1 SD greater variability, 1.29; 95% CI, 1.14-1.45) but not CVD events (HR, 1.05; 95% CI, 0.95-1.16) after adjusting for albuminuria, eGFR, and other CVD risk factors. Associations were similar when stratified by treatment arm and by baseline CKD status, when accounting for concurrent systolic blood pressure changes, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic medications during follow up. Limitations: Persons with diabetes and proteinuria > 1 g/d were excluded. Conclusions: In trial participants at high risk for CVD, greater eGFR variability was independently associated with all-cause mortality but not CVD events.
AB - Rationale and Objective: Although low estimated glomerular filtration rate (eGFR) is associated with cardiovascular disease (CVD) events and mortality, the clinical significance of variability in eGFR over time is uncertain. This study aimed to evaluate the associations between variability in eGFR and the risk of CVD events and all-cause mortality. Study Design: Longitudinal analysis of clinical trial participants. Settings and Participants: 7,520 Systolic Blood Pressure Intervention Trial (SPRINT) participants ≥50 year of age with 1 or more CVD risk factors. Predictors: eGFR variability, estimated by the coefficient of variation of eGFR assessments at the 6th, 12th, and 18-month study visits. Outcomes: The SPRINT primary CVD composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and all-cause mortality from month 18 to the end of follow-up. Analytical Approach: Cox models were used to evaluate associations between eGFR variability and CVD outcomes and all-cause mortality. Models were adjusted for demographics, randomization arm, CVD risk factors, albuminuria, and eGFR at month 18. Results: Mean age was 68 ± 9 years; 65% were men; and 58% were White. The mean eGFR was 73 ± 21 (SD) mL/min/1.73 m2 at 6 months. There were 370 CVD events and 154 deaths during a median follow-up of 2.4 years. Greater eGFR variability was associated with higher risk for all-cause mortality (hazard ratio [HR] per 1 SD greater variability, 1.29; 95% CI, 1.14-1.45) but not CVD events (HR, 1.05; 95% CI, 0.95-1.16) after adjusting for albuminuria, eGFR, and other CVD risk factors. Associations were similar when stratified by treatment arm and by baseline CKD status, when accounting for concurrent systolic blood pressure changes, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic medications during follow up. Limitations: Persons with diabetes and proteinuria > 1 g/d were excluded. Conclusions: In trial participants at high risk for CVD, greater eGFR variability was independently associated with all-cause mortality but not CVD events.
KW - CVD
KW - all-cause mortality
KW - cardiovascular disease
KW - cardiovascular event
KW - eGFR
KW - eGFR variability
KW - estimated glomerular filtration rate
KW - renal function
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U2 - 10.1053/j.ajkd.2020.10.016
DO - 10.1053/j.ajkd.2020.10.016
M3 - Article
C2 - 33333147
AN - SCOPUS:85103021270
SN - 0272-6386
VL - 78
SP - 48
EP - 56
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -