Ta-Wei Hsu1, Jia-Sin Liu2, Szu-Chun Hung3, Ko-Lin Kuo3, Yu-Kang Chang2, Yu-Chi Chen4, Chih-Cheng Hsu5, Der-Cherng Tarng6. 1. Division of Nephrology, Department of Internal Medicine, National Yang-Ming University Hospital, Ilan City, Taiwan. 2. Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. 3. Division of Nephrology, Buddhist Tzu Chi Hospital Taipei Branch, New Taipei, Taiwan. 4. Department and Institute of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan. 5. Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan5Department of Health Services Administration, China Medical University and Hospital, Taichung, Taiwan. 6. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan7Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Abstract
IMPORTANCE: The benefit of using a renin-angiotensin-aldosterone system blocker such as an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) for patients with advanced chronic kidney disease (CKD) remains undetermined. OBJECTIVE: To assess the effectiveness and safety of ACEI/ARB use for advanced predialysis CKD in patients with hypertension and anemia. DESIGN Prospective cohort study. SETTING: Taiwan. PARTICIPANTS: From January 1, 2000, through June 30, 2009, we selected 28 497 hypertensive adult patients with CKD. Serum creatinine levels were greater than 6 mg/dL, hematocrit levels were less than 28%, and patients were treated with erythropoiesis-stimulating agents. INTERVENTIONS: Users (n = 14,117) and nonusers (n = 14,380) of ACEIs/ARBs. MAIN OUTCOMES AND MEASURES: We used Cox proportional hazards regression models to estimate hazard ratios (HRs) for commencement of long-term dialysis and all-cause mortality for ACRI/ARB users vs nonusers. RESULTS: In a median follow-up of 7 months, 20,152 patients (70.7%) required long-term dialysis and 5696 (20.0%) died before progression to end-stage renal disease requiring dialysis. Use of ACEIs/ARBs was associated with a lower risk for long-term dialysis (HR, 0.94 [95% CI, 0.91-0.97]) and the composite outcome of long-term dialysis or death (0.94 [0.92-0.97]). The renal benefit of ACEI/ARB use was consistent across most patient subgroups, as was that of ACEI or ARB monotherapy. Compared with nonusers, the ACEI/ARB users had a higher hyperkalemia-associated hospitalization rate, but the risk of predialysis mortality caused by hyperkalemia was not significantly increased (HR, 1.03 [95% CI, 0.92-1.16]; P = .30). CONCLUSIONS AND RELEVANCE: Patients with stable hypertension and advanced CKD who receive therapy with ACEIs/ARBs exhibit an association with lower risk for long-term dialysis or death by 6%. This benefit does not increase the risk of all-cause mortality.
IMPORTANCE: The benefit of using a renin-angiotensin-aldosterone system blocker such as an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) for patients with advanced chronic kidney disease (CKD) remains undetermined. OBJECTIVE: To assess the effectiveness and safety of ACEI/ARB use for advanced predialysis CKD in patients with hypertension and anemia. DESIGN Prospective cohort study. SETTING: Taiwan. PARTICIPANTS: From January 1, 2000, through June 30, 2009, we selected 28 497 hypertensive adult patients with CKD. Serum creatinine levels were greater than 6 mg/dL, hematocrit levels were less than 28%, and patients were treated with erythropoiesis-stimulating agents. INTERVENTIONS: Users (n = 14,117) and nonusers (n = 14,380) of ACEIs/ARBs. MAIN OUTCOMES AND MEASURES: We used Cox proportional hazards regression models to estimate hazard ratios (HRs) for commencement of long-term dialysis and all-cause mortality for ACRI/ARB users vs nonusers. RESULTS: In a median follow-up of 7 months, 20,152 patients (70.7%) required long-term dialysis and 5696 (20.0%) died before progression to end-stage renal disease requiring dialysis. Use of ACEIs/ARBs was associated with a lower risk for long-term dialysis (HR, 0.94 [95% CI, 0.91-0.97]) and the composite outcome of long-term dialysis or death (0.94 [0.92-0.97]). The renal benefit of ACEI/ARB use was consistent across most patient subgroups, as was that of ACEI or ARB monotherapy. Compared with nonusers, the ACEI/ARB users had a higher hyperkalemia-associated hospitalization rate, but the risk of predialysis mortality caused by hyperkalemia was not significantly increased (HR, 1.03 [95% CI, 0.92-1.16]; P = .30). CONCLUSIONS AND RELEVANCE: Patients with stable hypertension and advanced CKD who receive therapy with ACEIs/ARBs exhibit an association with lower risk for long-term dialysis or death by 6%. This benefit does not increase the risk of all-cause mortality.
Authors: Samuel T Coffin; Dia R Waguespack; Nicholas A Haglund; Simon Maltais; Jamie P Dwyer; Mary E Keebler Journal: Cardiorenal Med Date: 2015-01-09 Impact factor: 2.041
Authors: Thomas C F Bodewes; Jeremy D Darling; Thomas F X O'Donnell; Sarah E Deery; Katie E Shean; Murray A Mittleman; Frans L Moll; Marc L Schermerhorn Journal: J Vasc Surg Date: 2017-11-02 Impact factor: 4.268