Treatment with an ACE inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) decreases the risk of progressing to dialysis or death among patients with stable hypertension and advanced chronic kidney disease (CKD), researchers reported online ahead of print in JAMA Internal Medicine.
Use of ACEIs or ARBs is known to delay progression of CKD in patients with and without diabetes, particularly in those with mild to moderate renal insufficiency, according to a statement issued by the journal. However, the benefit of using a renin-angiotensin-aldosterone system blocker in patients with advanced CKD has been less clear.
Ta-Wei Hsu, MD, of the Division of Nephrology at National Yang-Ming University Hospital in Ilan City, Taiwan, and colleagues launched a prospective cohort study to assess the effectiveness and safety of ACEI/ARB therapy for advanced predialysis CKD in persons with hypertension and anemia. The study involved 28,497 adults in Taiwan with hypertension and CKD, including 14,117 users and 14,380 nonusers of ACEIs/ARBs. The subjects, enrolled from January 2000 through June 2009, had serum creatinine levels greater than 6 mg/dL, had hematocrit levels lower than 28%, and were treated with erythropoiesis-stimulating agents.
During a median follow-up of seven months, 20,152 patients (70.7%) required long-term dialysis, and 5,696 (20%) died before progressing to end-stage renal disease requiring dialysis. Patients using ACE inhibitors/ARBs were 6% less likely than nonusers to require long-term dialysis and 6% less likely to reach the composite outcome of long-term dialysis or death.
“The renal benefit of ACEI/ARB use was consistent across most patient subgroups, as was that of ACEI or ARB monotherapy,” Dr. Hsu’s team wrote. “Compared with nonusers, the ACEI/ARB users had a higher hyperkalemia-associated hospitalization rate, but the risk of predialysis mortality caused by hyperkalemia was not significantly increased.”