Match!

Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report

Published on Dec 1, 2018in American Journal of Kidney Diseases6.65
· DOI :10.1053/j.ajkd.2018.06.010
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)
Cite
Abstract
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, but may result in long-term preservation of kidney function through the reductions in glomerular intracapillary pressure conferred by these agents. In this National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) report, we discuss the controversies regarding use of RAS blockade in patients with advanced kidney disease. We review available published data on this topic and provide perspective on the impact of RAS blockade on changes in eGFRs and potassium levels. We conclude that more research is needed to evaluate the therapeutic index of RAS blockade in patients with advanced CKD.
  • References (72)
  • Citations (2)
Cite
References72
Newest
Published on Jan 9, 2018in Circulation23.05
Jorge Plutzky58
Estimated H-index: 58
(Brigham and Women's Hospital),
George L. Bakris102
Estimated H-index: 102
(U of C: University of Chicago)
Article, see p 119 The link between cardiovascular disease (CVD) and diabetes mellitus has long been recorded, extending back to the advent of insulin therapy, when that therapeutic advance increased patient survival, allowing atherosclerotic complications to become more evident.1 Attention to the relationship between diabetes mellitus and CVD grew, fostered by forces such as the epidemic of obesity and diabetes mellitus, improved post–myocardial infarction survival, and increasing data linking ...
Published on Sep 1, 2017in Journal of The American Society of Nephrology8.55
Elaine Ku10
Estimated H-index: 10
,
George L. Bakris102
Estimated H-index: 102
(U of C: University of Chicago)
+ 7 AuthorsChi-yuan Hsu50
Estimated H-index: 50
The magnitude of decline in renal function that should be tolerated during intensive BP lowering and its association with risk of ESRD are unclear. To determine whether the acute declines in kidney function in the intensive BP lowering arm of two trials in CKD associated with higher risk of ESRD, we performed a retrospective study of 899 African American Study of Kidney Disease and Hypertension (AASK) and 761 Modification of Diet in Renal Disease (MDRD) Trial participants previously randomized t...
Published on Mar 9, 2017in BMJ27.60
Morten Schmidt27
Estimated H-index: 27
(Lond: University of London),
Kathryn E. Mansfield7
Estimated H-index: 7
(Lond: University of London)
+ 4 AuthorsLaurie A. Tomlinson17
Estimated H-index: 17
(Lond: University of London)
Objective To examine long term cardiorenal outcomes associated with increased concentrations of creatinine after the start of angiotensin converting enzyme inhibitor/angiotensin receptor blocker treatment. Design Population based cohort study using electronic health records from the Clinical Practice Research Datalink and Hospital Episode Statistics. Setting UK primary care, 1997-2014. Participants Patients starting treatment with angiotensin converting enzyme inhibitors or angiotensin receptor ...
Published on Mar 1, 2017in Kidney International8.31
Catherine M. Clase36
Estimated H-index: 36
(McMaster University),
Joshua I. Barzilay39
Estimated H-index: 39
(KP: Kaiser Permanente)
+ 6 AuthorsJohannes F.E. Mann58
Estimated H-index: 58
Initiation of blockade of the renin-angiotensin system may cause an acute decrease in glomerular filtration rate (GFR): the prognostic significance of this is unknown. We did a post hoc analysis of patients with, or at risk for, vascular disease, in two randomized controlled trials: Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and the Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease (TRANSCEND), whos...
Published on Jan 25, 2017in PLOS ONE2.78
Yun Jung Oh1
Estimated H-index: 1
,
Sun Moon Kim1
Estimated H-index: 1
(CBNU: Chungbuk National University)
+ 9 AuthorsWookyung Chung12
Estimated H-index: 12
(Gachon University)
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 ...
Published on May 1, 2016in American Journal of Kidney Diseases6.65
Xinfang Xie7
Estimated H-index: 7
(PKU: Peking University),
Youxia Liu4
Estimated H-index: 4
(PKU: Peking University)
+ 8 AuthorsHong Zhang42
Estimated H-index: 42
(PKU: Peking University)
Background There is much uncertainty regarding the relative effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in populations with chronic kidney disease (CKD). Study Design Systematic review and Bayesian network meta-analysis. Setting & Population Patients with CKD treated with renin-angiotensin system (RAS) inhibitors. Selection Criteria for Studies Randomized trials in patients with CKD treated with RAS inhibitors. Predictor ACE inhibitors an...
Published on Jan 1, 2016in Nephron2.08
Aimun Ahmed1
Estimated H-index: 1
,
Tom Jorna1
Estimated H-index: 1
,
Sunil Bhandari Frcp24
Estimated H-index: 24
Chronic kidney disease (CKD) is a worldwide public health problem associated with a high prevalence of cardiovascular disease (CVD) and impaired quality of life. Previous research for preventing loss
Published on Sep 30, 2015in Nephrology Dialysis Transplantation4.20
Sunil Bhandari Frcp24
Estimated H-index: 24
(Hull York Medical School),
Natalie Ives20
Estimated H-index: 20
(University of Birmingham)
+ 6 AuthorsMeguid El Nahas24
Estimated H-index: 24
Background Blood pressure (BP) control and reduction of urinary protein excretion using agents that block the renin–angiotensin aldosterone system are the mainstay of therapy for chronic kidney disease (CKD). Research has confirmed the benefits in mild CKD, but data on angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use in advanced CKD are lacking. In the STOP-ACEi trial, we aim to confirm preliminary findings which suggest that withdrawal of ACEi/ARB treatme...
Published on Jul 14, 2015in JAMA51.27
George L. Bakris102
Estimated H-index: 102
(U of C: University of Chicago),
Bertram Pitt99
Estimated H-index: 99
(UM: University of Michigan)
+ 7 AuthorsDavid A. Bushinsky53
Estimated H-index: 53
(UR: University of Rochester)
Importance Hyperkalemia is a potentially life-threatening condition predominantly seen in patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors with stage 3 or greater chronic kidney disease (CKD) who may also have diabetes, heart failure, or both. Objectives To select starting doses for a phase 3 study and to evaluate the long-term safety and efficacy of a potassium-binding polymer, patiromer, in outpatients with hyperkalemia. Design, Setting, and Participants Phase 2, mu...
Published on Jan 15, 2015in The New England Journal of Medicine70.67
Matthew R. Weir66
Estimated H-index: 66
(UMB: University of Maryland, Baltimore),
George L. Bakris102
Estimated H-index: 102
(U of C: University of Chicago)
+ 7 AuthorsBertram Pitt99
Estimated H-index: 99
(UM: University of Michigan)
Background Hyperkalemia increases the risk of death and limits the use of inhibitors of the renin–angiotensin–aldosterone system (RAAS) in high-risk patients. We assessed the safety and efficacy of patiromer, a nonabsorbed potassium binder, in a multicenter, prospective trial. Methods Patients with chronic kidney disease who were receiving RAAS inhibitors and who had serum potassium levels of 5.1 to less than 6.5 mmol per liter received patiromer (at an initial dose of 4.2 g or 8.4 g twice a day...
Cited By2
Newest
Edouard Fu (KI: Karolinska Institutet), Marco Trevisan3
Estimated H-index: 3
(KI: Karolinska Institutet)
+ -3 AuthorsJuan Jesús Carrero58
Estimated H-index: 58
(KI: Karolinska Institutet)
Background and objectives Data from observational and interventional studies provide discordant results regarding the relationship between creatinine increase after renin-angiotensin system inhibition (RASi) and adverse outcomes. We compared health outcomes among patients with different categories of increase in creatinine upon initiation of RASi in a large population-based cohort. Design, setting, participants, & measurements We performed a retrospective analysis of the Stockholm CREAtinine Mea...
Published on Mar 1, 2019in International Urology and Nephrology1.60
Tomasz Kaminski5
Estimated H-index: 5
(UMB: Medical University of Białystok),
Krystyna Pawlak22
Estimated H-index: 22
(UMB: Medical University of Białystok)
+ 4 AuthorsDariusz Pawlak23
Estimated H-index: 23
(UMB: Medical University of Białystok)
Purpose Indoxyl sulfate (IS) is one of the most potent uremic toxins involved in chronic kidney disease (CKD) progression, induction of inflammation, oxidative stress, and cardiovascular diseases occurrence. It is proved that hypertension is a common CVD complication and a major death risk factor as well as contributes for decline in a renal function. The aim of our study was to investigate how implementing of antihypertensive therapy impact IS concentrations and the associations between IS and ...