An analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) indicates that nearly all adults with chronic kidney disease (CKD) would have benefits that outweigh the harm from a systolic blood pressure target of ASN Kidney Week 2025 from November 5–9.
In a benefit-harm trade-off analysis of 2,012 participants with CKD, investigators found that when predicting individualized treatment effects for multiple outcomes and simulating preferences for participants who view the benefits of intensive blood pressure lowering (reductions in death, cardiovascular events, and cognitive impairment) as much more important than treatment-related harms (such as emergency room visits or hospitalizations for acute kidney injury and fainting), 100% had a positive net benefit favoring intensive blood pressure-lowering.
When simulating benefits and harms to have similar, intermediate importance, 9 out of 10 still had a positive net benefit.
Compared with people with earlier-stage CKD (estimated glomerular filtration rate (45–59 ml/min/1.73 m2), people with more advanced CKD (20–44 ml/min/1.73 m2) experienced more treatment-related harms from a lower systolic blood pressure goal; however, they also had larger benefits, which resulted in the more advanced CKD group having greater net benefits.
The findings, which are consistent with KDIGO Guidelines that recommend a systolic blood pressure target of
“This study demonstrates that evidence about blood pressure targets from SPRINT can be personalized to adults with hypertension and CKD by using each individual’s estimated risks and preferences for multiple outcomes related to blood pressure lowering, which could help facilitate shared decision-making conversations,” said corresponding author Alan Vera, a medical student at the University of California Davis.
More information:
Study: Individualized net benefit of intensive blood pressure lowering among persons with CKD in SPRINT (2025)
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