SPRINT: the study nephrologists might take with a grain of salt

Abstract

Patients with chronic kidney disease (CKD) experience several comorbidities, one of the most important being cardiovascular (CV) disease (CVD). For example, patients with stage IIIa/b CKD are more likely to die from CVD than to survive to reach end-stage renal disease. Management of hypertension, a major determinant of CV outcomes and progressive renal dysfunction, remains elusively controversial in the CKD population. In an effort to clarify this, the National Institutes of Health-funded Systolic Blood Pressure Intervention Trial (SPRINT) compared the traditional systolic 140 mm Hg goal with a more aggressive systolic goal of 120 mm Hg in a cohort of nondiabetic patients at elevated CV risk. SPRINT showed statistically significant reductions in combined CV events across all prespecified subgroups, including patients with CKD. However, SPRINT did not systematically include CKD patients, and the CKD data are merely offered as a convenience sampling. This directly limits external generalizability to CKD patients since only approximately 30% of SPRINT patients in the 120 mm Hg arm had CKD. SPRINT reaffirms the need for blood pressure control, especially in CKD patients, but is not a sufficient standalone guideline for nephrologists treating CKD in the community. A SPRINT-style study dedicated to the CKD population would be more appropriate if traditional CKD guidelines are to be challenged conclusively.