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

Autor: Chungsik Lee, Ji Yong Jung, Jae Hyun Chang, Sun Moon Kim, Wookyung Chung, Ae Jin Kim, Byung Chul Shin, Hyun Hee Lee, Han Ro, Hyun Lee Kim, Yun Jung Oh, Jong Hoon Chung
Rok vydání: 2017
Předmět:
Male
Nephrology
Peptide Hormones
lcsh:Medicine
Blood Pressure
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
Pathology and Laboratory Medicine
Kidney
Biochemistry
Vascular Medicine
Renin-Angiotensin System
Endocrinology
0302 clinical medicine
Chronic Kidney Disease
Medicine and Health Sciences
Medicine
030212 general & internal medicine
lcsh:Science
Geriatric Nephrology
Multidisciplinary
Hazard ratio
Middle Aged
Prognosis
Survival Rate
Proteinuria
Treatment Outcome
Disease Progression
Female
Anatomy
Research Article
Adult
medicine.medical_specialty
Endocrine Disorders
Angiotensin Receptor Antagonists
03 medical and health sciences
Signs and Symptoms
Diagnostic Medicine
Diabetes mellitus
Internal medicine
Diabetes Mellitus
Humans
Renal Insufficiency
Chronic
Intensive care medicine
Survival rate
Aged
Retrospective Studies
business.industry
lcsh:R
Geriatric nephrology
Biology and Life Sciences
Retrospective cohort study
Renal System
medicine.disease
Hormones
Blockade
Geriatrics
Metabolic Disorders
lcsh:Q
business
Kidney disease
Zdroj: PLoS ONE, Vol 12, Iss 1, p e0170874 (2017)
PLoS ONE
ISSN: 1932-6203
Popis: 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.
Databáze: OpenAIRE
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