Association of Acute Kidney Injury with Cardiovascular Events and Death in Systolic Blood Pressure Intervention Trial

Abstract

Rationale and Objective: In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. Study Design: Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. Setting and Participants: Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). Predictor: AKI episodes. Outcomes: The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. Results: Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05–2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56–3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. Limitations: The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. Conclusions: Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.

Cardiovascular Events Among Survivors of Sepsis Hospitalization: A Retrospective Cohort Analysis

“…AKI itself is a known predictor of death and CVD events, and our data demonstrate an additive risk of sepsis and AKI for postdischarge events. 14 , 15 , 16 The consistent association between sepsis and adverse outcomes across subgroups with and without various manifestations of critical illness helps to demonstrate the potential hazard from sepsis beyond the known harmful effects of its downstream complications and argues against the presence of critical illness itself as the sole mediator of this association.…”

“… 6 , 12 , 13 Complications of sepsis such as AKI have likewise been associated with a higher risk of subsequent CVD events. 14 , 15 , 16 If the elevated risk of CVD events after recovery from sepsis was amenable to preventative therapy, then cardiovascular prevention strategies might be an important component of the care of survivors of sepsis.…”

Characterization of features and outcomes of young patients (< 45 years) presenting with ST-segment elevation myocardial infarction

“…Similar findings were demonstrated by Pablo et al, who examined > 19,000 patients and showed that MACE in the follow-up was linked with dyslipidemia and lower LVEF [ 24 ]. Also, in another study evaluating the impact of impaired renal function on cardiovascular outcomes, the investigators have shown that impaired renal functions were associated with higher rates of acute coronary syndrome, myocardial infarction, decompensated heart failure, stroke and death [ 25 ].…”

A clinical study of drugs associated with acute kidney injury in the Chinese population

“…A similar observation has also been reported in a study by Tonelli et al [11] which revealed that elderly male patients were more susceptible to AKI than other groups investigated. Studies have also shown that the incidence of AKI is rising among the elderly patients due to combinations of multiple diseases which include diabetes, vascular diseases and chronic kidney diseases [12,13]. These patients also have a higher degree of exposure to several nephrotoxic agents during the diagnostic procedures and drug administration [14].…”