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The Impact of Renin-Angiotensin System Blockade on Renal Outcomes and Mortality in Pre-Dialysis Patients with Advanced Chronic Kidney Disease.

Published on Jan 25, 2017in PLOS ONE2.78
· DOI :10.1371/journal.pone.0170874
Yun Jung Oh1
Estimated H-index: 1
,
Sun Moon Kim1
Estimated H-index: 1
(CBNU: Chungbuk National University)
+ 9 AuthorsJi Yong Jung10
Estimated H-index: 10
(Gachon University)
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Abstract
Renin-angiotensin-system (RAS) blockade is thought to slow renal progression in patients with chronic kidney disease (CKD). However, it remains uncertain if the habitual use of RAS inhibitors affects renal progression and outcomes in pre-dialysis patients with advanced CKD. In this multicenter retrospective cohort study, we identified 2,076 pre-dialysis patients with advanced CKD (stage 4 or 5) from a total of 33,722 CKD patients. RAS blockade users were paired with non-users for analyses using inverse probability of treatment-weighted (IPTW) and propensity score (PS) matching. The outcomes were renal death, all-cause mortality, hospitalization for hyperkalemia, and interactive factors as composite outcomes. RAS blockade users showed an increased risk of renal death in PS-matched analysis (hazard ratio [HR], 1.381; 95% CI, 1.071–1.781; P = 0.013), which was in agreement with the results of IPTW analysis (HR, 1.298; 95% CI, 1.123–1.500; P < 0.001). The risk of composite outcomes was higher in RAS blockade users in IPTW (HR, 1.154; 95% CI, 1.016–1.310; P = 0.027), but was marginal significance in PS matched analysis (HR, 1.243; 95% CI, 0.996–1.550; P = 0.054). The habitual use of RAS blockades in pre-dialysis patients with advanced CKD may have a detrimental effect on renal outcome without improving all-cause mortality. Further studies are warranted to determine whether withholding RAS blockade may lead to better outcomes in these patients.
  • References (59)
  • Citations (1)
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References59
Newest
Published on Mar 1, 2016in American Journal of Kidney Diseases6.65
Rajiv Saran49
Estimated H-index: 49
,
Yi Li44
Estimated H-index: 44
+ 42 AuthorsElizabeth Cope5
Estimated H-index: 5
Author(s): Saran, R; Li, Y; Robinson, B; Abbott, KC; Agodoa, LYC; Ayanian, J; Bragg-Gresham, J; Balkrishnan, R; Chen, JLT; Cope, E; Eggers, PW; Gillen, D; Gipson, D; Hailpern, SM; Hall, YN; He, K; Herman, W; Heung, M; Hirth, RA; Hutton, D; Jacobsen, SJ; Kalantar-Zadeh, K; Kovesdy, CP; Lu, Y; Molnar, MZ; Morgenstern, H; Nallamothu, B; Nguyen, DV; O'Hare, AM; Plattner, B; Pisoni, R; Port, FK; Rao, P; Rhee, CM; Sakhuja, A; Schaubel, DE; Selewski, DT; Shahinian, V; Sim, JJ; Song, P; Streja, E; Tamur...
Published on Jan 1, 2016
Sripal Bangalore50
Estimated H-index: 50
(NYU: New York University),
Robert J. Fakheri7
Estimated H-index: 7
(NYU: New York University)
+ 3 AuthorsFranz H. Messerli80
Estimated H-index: 80
(ISMMS: Icahn School of Medicine at Mount Sinai)
Abstract Objectives To compare the efficacy and safety of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in patients without heart failure. Patients and Methods Meta-analysis of randomized trials identified using PubMed, Embase, and Cochrane Central Register of Controlled Trials searches from January 1, 1980, through April 13, 2015, of ACEis and ARBs compared with placebo or active controls and corroborated with head-to-head trials of ARBs vs ACEis. Out...
Published on Jun 1, 2015in Kidney International8.31
Dong-Chan Jin1
Estimated H-index: 1
(Catholic University of Korea)
The Korean Society of Nephrology (KSN) end-stage renal disease (ESRD) registry was established in 1985 in which all KSN members are participating voluntarily: the ‘Insan Prof. Byung-Suk Min Memorial ESRD Patient Registry'. The ESRD registry committee of KSN has collected the data through the internet online program that was opened in 2001 and revised in 2013. The registry internet program has collected data throughout the years, which includes dialysis center information, vascular access, dialys...
Published on Jan 1, 2015in World journal of nephrology
Hiromichi Suzuki40
Estimated H-index: 40
,
Tomohiro Kikuta11
Estimated H-index: 11
+ 1 AuthorsUkihiro Hamada2
Estimated H-index: 2
The use of renin-angiotensin system (RAS) inhibitors, such angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers, to slow progression of chronic kidney disease (CKD) in a large group dominated by elderly people in the real world is not supported by available evidence. Large-scale clinical trials had many faults, among them a lack of focus on the elderly. However, it would be difficult to conduct clinical trials of a similar scale in elderly CKD patients. Besides, progression ...
Published on May 1, 2014in JAMA Internal Medicine20.77
Jun Cheng4
Estimated H-index: 4
(ZJU: Zhejiang University),
Wen Zhang3
Estimated H-index: 3
+ 5 AuthorsJianghua Chen16
Estimated H-index: 16
(ZJU: Zhejiang University)
DATA EXTRACTION AND SYNTHESIS Dichotomous outcome data from individual trials were analyzed using the risk ratio (RR) measure and its 95% CI with random-effects models. We estimated the difference between the estimates of the subgroups according to tests for interaction. We performed meta-regression analyses to identify sources of heterogeneity. MAIN OUTCOMES AND MEASURES Primary end points were all-cause mortality and death from CV causes. Secondary end points were the effects of ACEIs and ARBs...
Published on Apr 29, 2014in Cochrane Database of Systematic Reviews7.75
Davide Bolignano23
Estimated H-index: 23
,
Suetonia C. Palmer38
Estimated H-index: 38
(University of Otago)
+ 1 AuthorsGiovanni F.M. Strippoli57
Estimated H-index: 57
(Children's Hospital at Westmead)
Background Treatment with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is increasingly used to reduce proteinuria and retard the progression of chronic kidney disease (CKD). However, resolution of proteinuria may be incomplete with these therapies and the addition of an aldosterone antagonist may be added to further prevent progression of CKD. This is an update of a review first published in 2009. Objectives To evaluate the effect of aldosterone antagon...
Published on Mar 1, 2014in JAMA Internal Medicine20.77
Ta-Wei Hsu3
Estimated H-index: 3
(NYMU: National Yang-Ming University),
Jia-Sin Liu6
Estimated H-index: 6
(NHRI: National Health Research Institutes)
+ 5 AuthorsDer-Cherng Tarng31
Estimated H-index: 31
(NYMU: National Yang-Ming University)
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...
Published on Feb 5, 2014in JAMA51.27
Paul A. James21
Estimated H-index: 21
(UI: University of Iowa),
Suzanne Oparil94
Estimated H-index: 94
(UAB: University of Alabama at Birmingham)
+ 14 AuthorsOlugbenga Ogedegbe12
Estimated H-index: 12
(NYU: New York University)
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the managemen...
Published on Sep 1, 2013in Kidney International8.31
K. Andrassy34
Estimated H-index: 34
(Heidelberg University)
To the Editor: ‘KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease’1 fills a gap, now including very recent and new insights into the diagnosis and therapy of chronic renal disease. The structured presentation emphasizes this in various chapters coherently, including pediatric considerations. It is to be expected that these guidelines will represent the future basis for quick information on chronic kidney disease and not only for nephrologists. As ...
Published on Jul 1, 2013in Journal of Hypertension4.25
Giuseppe Mancia127
Estimated H-index: 127
,
Robert Fagard104
Estimated H-index: 104
+ 22 AuthorsAnna F. Dominiczak95
Estimated H-index: 95
Table of ContentsIntroductionPrinciplesNew aspectsEpidemiological aspectsRelationship of blood pressure to cardiovascular and renal damageDefinition and classification of hypertensionPrevalence of hypertensionHypertension and total cardiovascular riskAssessment of total cardiovascular riskLimitation
Cited By1
Newest
Published on Dec 1, 2018in American Journal of Kidney Diseases6.65
Matthew R. Weir28
Estimated H-index: 28
(UMB: University of Maryland, Baltimore),
Jay I. Lakkis2
Estimated H-index: 2
(U.H.: University of Hawaii at Manoa)
+ 4 AuthorsElaine Ku10
Estimated H-index: 10
(UCSF: University of California, San Francisco)
Multiple clinical trials have demonstrated that renin-angiotensin system (RAS) blockade with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers effectively reduces chronic kidney disease (CKD) progression. However, most clinical trials excluded participants with advanced CKD (ie, estimated glomerular filtration rate [eGFR] 2 ). It is acknowledged that initiation of RAS blockade is often associated with an acute reduction in eGFR, which is thought to be functional, b...
Published on Jun 5, 2018in Journal of the American Heart Association4.66
John M. Brooks21
Estimated H-index: 21
(USC: University of South Carolina),
Cole G. Chapman2
Estimated H-index: 2
(USC: University of South Carolina)
+ 9 AuthorsElizabeth A. Chrischilles45
Estimated H-index: 45
(UI: University of Iowa)
Background Our objective is to estimate the effects associated with higher rates of renin‐angiotensin system antagonists, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs), in secondary prevention for geriatric (aged >65 years) patients with new ischemic strokes by chronic kidney disease (CKD) status. Methods and Results The effects of ACEI/ARBs on survival and renal risk were estimated by CKD status using an instrumental variable (IV) estimator. Instruments ...