Longer Predialysis ACEi/ARB Utilization Is Associated With Reduced Postdialysis Mortality - 29/08/20
Abstract |
Background |
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARB) improve predialysis outcomes; however, ACEi/ARB are underused in patients transitioning to dialysis. We examined the association of different patterns of predialysis ACEi/ARB use with postdialysis survival and whether potentially modifiable adverse events are associated with lower predialysis ACEi/ARB use.
Methods |
This was a historic cohort study of 34,676 US veterans with, and 10,690 without, ACEi/ARB exposure in the 3-year predialysis period who subsequently transitioned to dialysis between 2007 and 2014. Associations of different patterns of predialysis ACEi/ARB use with postdialysis all-cause mortality and with predialysis acute kidney injury and hyperkalemia events were examined using multivariable adjusted regression analyses.
Results |
The mean age of the cohort was 70 years, 98% were males and 27% were African Americans. Compared to ACEi/ARB nonuse, continuous ACEi/ARB use was associated with lower postdialysis all-cause mortality (adjusted hazard ratio [aHR]; 95% confidence interval [95% CI] 0.87; 0.83-0.92). In analyses modeling the duration of predialysis ACEi/ARB use, ACEi/ARB use of 50%-74% and ≥75% were associated with lower mortality compared to nonuse (adjusted hazard ratio, 95% confidence interval 0.96, 0.92-0.99 and 0.91; 0.88-0.94, respectively), whereas no increase in postdialysis survival was observed with shorter predialysis ACEi/ARB use. Predialysis acute kidney injury was associated with shorter duration (<50%) of ACEi/ARB use and hyperkalemia was associated with interrupted and ACEi/ARB use of <75%.
Conclusions |
Longer predialysis ACEi/ARB exposure was associated with lower postdialysis mortality. Prospective studies are needed to evaluate the benefits of strategies enabling uninterrupted predialysis ACEi/ARB use.
Le texte complet de cet article est disponible en PDF.Keywords : Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), Dialysis, End-stage kidney disease (ESKD), Mortality, Veterans
Plan
| Funding: This study was supported by the grant U01-DK102163 from the National Institute of Health (NIH) to CPK and KKZ, and by resources from the US Department of Veterans Affairs. The data reported here have been supplied by the United States Renal Data System (USRDS). Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). |
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| Conflicts of Interest: EOG, AN, BMW, KKZ, and CPK are employees of the US Department of Veterans Affairs. Opinions expressed in this paper are those of the authors’ and do not necessarily represent the opinion of the Department of Veterans Affairs. EOG reports honoraria from Amgen and Takeda. MZM reports honoraria from Merck, CareDx, and AbbVie. ES reports research support from Department of Veterans Affairs. KKZ reports honoraria and/or research support from Abbott, Abbvie, Cara Therapeutics, Akebia, Alexion, Amgen, Astra-Zeneca, Aveo, BBraun, Chugai, Cytokinetics, Daiichi, DaVita, Fresenius, Genentech, Haymarket Media, Hospira, Kabi, Keryx, Kissei, Novartis, OPKO, National Institutes of Health, Pfizer, Regulus, Relypsa, Resverlogix, Dr Schaer, Sandoz, Sanofi, Shire, Department of Veterans Affairs, Vifor, UpToDate, and. ZS-Pharma. CPK reports honoraria from Amgen, Astra-Zeneca, Bayer, Cara Therapeutics, Reata, Takeda, and Tricida. AN, KS, PP, AG, BMW, FT, and report none. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 133 - N° 9
P. 1065 - septembre 2020 Retour au numéro
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