Evidence map›Paper›PMID 37269972›Full record

Observational studyAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2023

Acute Declines in Estimated GFR in Blood Pressure Target Trials and Risk of Adverse Outcomes.

Elaine Ku, Charles E McCulloch, Timothy P Copeland, Lesley A Inker, Hocine Tighiouart, Mark J Sarnak

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Article
  4. Impact of intensive blood pressure control on kidney outcomes.Current opinion in nephrology and hypertension · 2025
    Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Elaine KuDepartment of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. Electronic address: elaine.ku@ucsf.edu.
Charles E McCullochDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
Timothy P CopelandDepartment of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA.
Lesley A InkerDepartment of Medicine, Division of Nephrology, Boston, MA.
Hocine TighiouartTufts Clinical and Translational Science Institute, Tufts University, Boston, MA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
Mark J SarnakDepartment of Medicine, Division of Nephrology, Boston, MA.

Funding

Acute declines in kidney function during blood pressure interventions in CKDR01DK121904 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KU, ELAINE, SARNAK, MARK J · 2020 to 2023
$2.9M
NIDDK NIH HHS R01 DK121904
6 · The paper itself

Abstract

RATIONALE &

objectiveAcute decreases in glomerular filtration rate (GFR) occur commonly during intensive blood pressure (BP) lowering. Our objective was to determine the relationship between acute decreases in estimated GFR and patient outcomes. STUDY

designRetrospective observational study. SETTING &

participantsParticipants from 4 randomized controlled trials of intensive BP lowering in chronic kidney disease (Modification of Diet in Renal Disease study, African American Study of Kidney Disease and Hypertension, Systolic Blood Pressure Intervention Trial, and Action to Control Cardiovascular Risk in Diabetes trial). EXPOSURE: A 4-category exposure defined by the level of acute decrease in estimated GFR (defined as>15% vs≤15% between baseline and month 4) and the randomization to intensive versus usual BP control. OUTCOMES: Risk of kidney replacement therapy (primary outcome), defined as the need for dialysis or transplant except in the Action to Control Cardiovascular Risk in Diabetes trial, which defined its kidney outcome as a composite occurrence of serum creatinine concentration>3.3mg/dL, kidney failure, or kidney replacement therapy. ANALYTICAL APPROACH: Multivariable Cox models.

resultsWe included 4,473 individuals randomly assigned to intensive versus usual BP control who had a total of 351 kidney outcomes and 304 deaths during median follow-up durations of 22 and 24 months, respectively. Approximately 14% of participants exhibited an acute decrease in eGFR, 11.0% in the usual BP treatment arm and 17.8% in the intensive BP treatment arm. In adjusted models, compared with a≤15% eGFR decrease in the usual BP arm, a≤15% eGFR decrease in the intensive BP control arm was associated with lower risk of the kidney outcome (HR, 0.75; 95% CI, 0.57-0.98). In contrast, a>15% decrease in eGFR was associated with a higher risk of the kidney outcome in the usual (HR, 2.47; 95% CI, 1.80-3.38) and intensive BP treatment arms (HR, 1.99; 95% CI, 1.45-2.73) compared with a≤15% decrease in the usual BP arm. LIMITATIONS: Observational study, residual confounding.

conclusionsDecreases in eGFR of>15% in the usual and intensive BP treatment arms were associated with a higher risk of kidney outcomes compared with a≤15% decrease in the usual BP arm and may be a harbinger of adverse outcomes.

Indexed as

HypertensionRenal Insufficiency, ChronicAntihypertensive AgentsBlood PressureGlomerular Filtration RateHumansKidneyAntihypertensive Agentschronic kidney diseaseend-stage kidney diseasehypertension

Identifiers

PMID37269972
PMCPMC12596040

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.