Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease : A Systematic Review and Retrospective Individual Participant-Level Meta-analysis of Clinical Trials.

Autor:	Ku E; Departments of Medicine and Pediatrics, Division of Nephrology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (E.K.)., Inker LA; Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.)., Tighiouart H; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts (H.T.)., McCulloch CE; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (C.E.M.)., Adingwupu OM; Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.)., Greene T; Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah (T.G.)., Estacio RO; Ambulatory Care Services, Denver Health, and Department of General Internal Medicine, University of Colorado at Denver, Health Sciences Center, Denver, Colorado (R.O.E.)., Woodward M; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia, and The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom (M.W.)., de Zeeuw D; Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands (D.deZ.)., Lewis JB; Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee (J.B.L.)., Hannedouche T; University of Strasbourg, AURAL, Strasbourg, France (T.H.)., Jafar TH; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (T.H.J.)., Imai E; Nakayamadera Imai Clinic, Takarazuka, Japan (E.I.)., Remuzzi G; Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (G.R.)., Heerspink HJL; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (H.J.L.H.)., Hou FF; Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China (F.F.H.)., Toto RD; University of Texas Southwestern Medical Center, Dallas, Texas (R.D.T.)., Li PK; Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (P.K.L.)., Sarnak MJ; Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (L.A.I., O.M.A., M.J.S.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2024 Jul; Vol. 177 (7), pp. 953-963. Date of Electronic Publication: 2024 Jul 02.
DOI:	10.7326/M23-3236
Abstrakt:	Background: In patients with advanced chronic kidney disease (CKD), the effects of initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) on the risk for kidney failure with replacement therapy (KFRT) and death remain unclear. Purpose: To examine the association of ACEi or ARB treatment initiation, relative to a non-ACEi or ARB comparator, with rates of KFRT and death. Data Sources: Ovid Medline and the Chronic Kidney Disease Epidemiology Collaboration Clinical Trials Consortium from 1946 through 31 December 2023. Study Selection: Completed randomized controlled trials testing either an ACEi or an ARB versus a comparator (placebo or antihypertensive drugs other than ACEi or ARB) that included patients with a baseline estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m 2 . Data Extraction: The primary outcome was KFRT, and the secondary outcome was death before KFRT. Analyses were done using Cox proportional hazards models according to the intention-to-treat principle. Prespecified subgroup analyses were done according to baseline age (<65 vs. ≥65 years), eGFR (<20 vs. ≥20 mL/min/1.73 m 2 ), albuminuria (urine albumin-creatinine ratio <300 vs. ≥300 mg/g), and history of diabetes. Data Synthesis: A total of 1739 participants from 18 trials were included, with a mean age of 54.9 years and mean eGFR of 22.2 mL/min/1.73 m 2 , of whom 624 (35.9%) developed KFRT and 133 (7.6%) died during a median follow-up of 34 months (IQR, 19 to 40 months). Overall, ACEi or ARB treatment initiation led to lower risk for KFRT (adjusted hazard ratio, 0.66 [95% CI, 0.55 to 0.79]) but not death (hazard ratio, 0.86 [CI, 0.58 to 1.28]). There was no statistically significant interaction between ACEi or ARB treatment and age, eGFR, albuminuria, or diabetes ( P for interaction > 0.05 for all). Limitation: Individual participant-level data for hyperkalemia or acute kidney injury were not available. Conclusion: Initiation of ACEi or ARB therapy protects against KFRT, but not death, in people with advanced CKD. Primary Funding Source: National Institutes of Health. (PROSPERO: CRD42022307589). Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3236.
Databáze:	MEDLINE
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