Miklos Z Molnar1, Kamyar Kalantar-Zadeh2, Evan H Lott3, Jun Ling Lu4, Sandra M Malakauskas5, Jennie Z Ma6, Darryl L Quarles4, Csaba P Kovesdy7. 1. Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine Medical Center, Irvine, California; Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California. 2. Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine Medical Center, Irvine, California; Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California. 3. VA Informatics and Computing Infrastructure, Salt Lake City, Utah. 4. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee. 5. Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia; Division of Nephrology, University of Virginia, Charlottesville, Virginia. 6. Division of Nephrology, University of Virginia, Charlottesville, Virginia. 7. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. Electronic address: csaba.kovesdy@va.gov.
Abstract
OBJECTIVES: The study objective was to assess the association between angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use and mortality in patients with chronic kidney disease (CKD). BACKGROUND: There is insufficient evidence about the association of ACEI or ARBs with mortality in patients with CKD. METHODS: A logistic regression analysis was used to calculate the propensity of ACEI/ARB initiation in 141,413 U.S. veterans with nondialysis CKD who were previously unexposed to ACEI/ARB treatment. We examined the association of ACEI/ARB administration with all-cause mortality in patients matched by propensity scores using the Kaplan-Meier method and Cox models in "intention-to-treat" analyses and in generalized linear models with binary outcomes and inverse probability of treatment weights in "as-treated" analyses. RESULTS: The age of the patients at baseline was 75 ± 10 years, 8% of patients were black, and 22% were diabetic. ACEI/ARB administration was associated with a significantly lower risk of mortality both in the intention-to-treat analysis (hazard ratio: 0.81, 95% confidence interval: 0.78 to 0.84; p < 0.001) and the as-treated analysis with inverse probability of treatment weights (odds ratio: 0.37, 95% confidence interval: 0.34 to 0.41; p < 0.001). The association of ACEI/ARB treatment with lower risk of mortality was present in all examined subgroups. CONCLUSIONS: In this large contemporary cohort of nondialysis-dependent patients with CKD, ACEI/ARB administration was associated with greater survival.
OBJECTIVES: The study objective was to assess the association between angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use and mortality in patients with chronic kidney disease (CKD). BACKGROUND: There is insufficient evidence about the association of ACEI or ARBs with mortality in patients with CKD. METHODS: A logistic regression analysis was used to calculate the propensity of ACEI/ARB initiation in 141,413 U.S. veterans with nondialysis CKD who were previously unexposed to ACEI/ARB treatment. We examined the association of ACEI/ARB administration with all-cause mortality in patients matched by propensity scores using the Kaplan-Meier method and Cox models in "intention-to-treat" analyses and in generalized linear models with binary outcomes and inverse probability of treatment weights in "as-treated" analyses. RESULTS: The age of the patients at baseline was 75 ± 10 years, 8% of patients were black, and 22% were diabetic. ACEI/ARB administration was associated with a significantly lower risk of mortality both in the intention-to-treat analysis (hazard ratio: 0.81, 95% confidence interval: 0.78 to 0.84; p < 0.001) and the as-treated analysis with inverse probability of treatment weights (odds ratio: 0.37, 95% confidence interval: 0.34 to 0.41; p < 0.001). The association of ACEI/ARB treatment with lower risk of mortality was present in all examined subgroups. CONCLUSIONS: In this large contemporary cohort of nondialysis-dependent patients with CKD, ACEI/ARB administration was associated with greater survival.
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