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Is Chronic Kidney Disease Progression Influenced by the Type of Renin-Angiotensin-System Blocker Used?
Nephron. 2019; 143(2):100-107.N

Abstract

INTRODUCTION

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce proteinuria and slow renal disease progression more effectively than other therapies in patients with chronic kidney disease (CKD). However, differences regarding efficacy and safety between these therapies remain controversial.

OBJECTIVES

Aim of this study was to analyze the different treatment effect of ACEI, ARB, and non-ACEI/ARB in CKD progression. The primary outcome was survival to end-stage renal disease (ESRD) and/or death and to ESRD censored by all-cause death, secondary outcomes were proteinuria reduction and hyperkalemia.

METHODS

We analyzed data from 1,120 patients extracted from the National Renal Healthcare Program cohort, which included 17,238 CKD nondialysis subjects who were successively monitored between -September 1, 2004 and August 31, 2016. Inclusion criteria were at least a 1-year follow-up, 3 clinical visits, and no previous treatment with ACEI or ARB. From the baseline visit onward, patients continued with 3 different treatment schemes: no ACEI/ARB, started on ACEI or ARB, but while avoiding both treatments in combination. Chi2, t test, binary logistic regression, and multivariate regression models (Cox proportional Hazard model and competing risk Fine and Gray model were used for statistical analysis.

RESULTS

Mean age and follow-up were 67.9 (± 15) and 3.8 (± 2) years, respectively. Estimated glomerular filtration rate averaged 42.1 ± 23 mL/min/1.73 m2 and 300 (27%) patients were diabetics. Progression to ESRD was significantly worse in the no ACEI/ARB group (hazard ratio [HR] 4.23, 95% CI 1.28-13.92) versus ACEI (reference group; p = 0.01). The analysis by competing-risks' regression showed significantly higher risk of ESRD in the no ACEI/ARB group (HR 3.63, 95% CI 1.34-9.85) versus ACEI (p = 0.01). There were no significant differences between ACEI and ARB groups (HR 1.31, 95% CI 0.37-4.66) regarding the risk of progression to ESRD. Survival was similar in all 3 groups (p = 0.051). Statistically significantly more patients experienced reductions in proteinuria/albuminuria in ACEI and ARB groups (together) versus no ACEI/ARB group (p = 0.016, OR 1.82, 95% CI 1.12-2.94). No difference in hyperkalemia frequency was found between them (p = 0.17).

CONCLUSIONS

In patients with CKD, treatment with ACEI or ARB had a superior effect than no ACEI or ARB treatment on slowing kidney disease progression and on proteinuria reduction. Efficacy of ACEI and ARB was comparable.

Authors+Show Affiliations

Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Fondo Nacional de Recursos, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Programa de Salud Renal del Uruguay, Montevideo, Uruguay.Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay, lilianagad@gmail.com. Programa de Salud Renal del Uruguay, Montevideo, Uruguay, lilianagad@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31203280

Citation

Silvariño, Ricardo, et al. "Is Chronic Kidney Disease Progression Influenced By the Type of Renin-Angiotensin-System Blocker Used?" Nephron, vol. 143, no. 2, 2019, pp. 100-107.
Silvariño R, Rios P, Baldovinos G, et al. Is Chronic Kidney Disease Progression Influenced by the Type of Renin-Angiotensin-System Blocker Used? Nephron. 2019;143(2):100-107.
Silvariño, R., Rios, P., Baldovinos, G., Chichet, M. A., Perg, N., Sola, L., Saona, G., De Souza, N., Lamadrid, V., & Gadola, L. (2019). Is Chronic Kidney Disease Progression Influenced by the Type of Renin-Angiotensin-System Blocker Used? Nephron, 143(2), 100-107. https://doi.org/10.1159/000500925
Silvariño R, et al. Is Chronic Kidney Disease Progression Influenced By the Type of Renin-Angiotensin-System Blocker Used. Nephron. 2019;143(2):100-107. PubMed PMID: 31203280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is Chronic Kidney Disease Progression Influenced by the Type of Renin-Angiotensin-System Blocker Used? AU - Silvariño,Ricardo, AU - Rios,Pablo, AU - Baldovinos,Graciela, AU - Chichet,María Alejandra, AU - Perg,Nancy, AU - Sola,Laura, AU - Saona,Gustavo, AU - De Souza,Nancy, AU - Lamadrid,Verónica, AU - Gadola,Liliana, Y1 - 2019/06/14/ PY - 2018/02/08/received PY - 2019/05/11/accepted PY - 2019/6/17/pubmed PY - 2020/5/16/medline PY - 2019/6/17/entrez KW - Angiotensin receptor blocker KW - Angiotensin-converting enzyme inhibitor KW - Chronic kidney disease KW - Proteinuria KW - Renin angiotensin system SP - 100 EP - 107 JF - Nephron JO - Nephron VL - 143 IS - 2 N2 - INTRODUCTION: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce proteinuria and slow renal disease progression more effectively than other therapies in patients with chronic kidney disease (CKD). However, differences regarding efficacy and safety between these therapies remain controversial. OBJECTIVES: Aim of this study was to analyze the different treatment effect of ACEI, ARB, and non-ACEI/ARB in CKD progression. The primary outcome was survival to end-stage renal disease (ESRD) and/or death and to ESRD censored by all-cause death, secondary outcomes were proteinuria reduction and hyperkalemia. METHODS: We analyzed data from 1,120 patients extracted from the National Renal Healthcare Program cohort, which included 17,238 CKD nondialysis subjects who were successively monitored between -September 1, 2004 and August 31, 2016. Inclusion criteria were at least a 1-year follow-up, 3 clinical visits, and no previous treatment with ACEI or ARB. From the baseline visit onward, patients continued with 3 different treatment schemes: no ACEI/ARB, started on ACEI or ARB, but while avoiding both treatments in combination. Chi2, t test, binary logistic regression, and multivariate regression models (Cox proportional Hazard model and competing risk Fine and Gray model were used for statistical analysis. RESULTS: Mean age and follow-up were 67.9 (± 15) and 3.8 (± 2) years, respectively. Estimated glomerular filtration rate averaged 42.1 ± 23 mL/min/1.73 m2 and 300 (27%) patients were diabetics. Progression to ESRD was significantly worse in the no ACEI/ARB group (hazard ratio [HR] 4.23, 95% CI 1.28-13.92) versus ACEI (reference group; p = 0.01). The analysis by competing-risks' regression showed significantly higher risk of ESRD in the no ACEI/ARB group (HR 3.63, 95% CI 1.34-9.85) versus ACEI (p = 0.01). There were no significant differences between ACEI and ARB groups (HR 1.31, 95% CI 0.37-4.66) regarding the risk of progression to ESRD. Survival was similar in all 3 groups (p = 0.051). Statistically significantly more patients experienced reductions in proteinuria/albuminuria in ACEI and ARB groups (together) versus no ACEI/ARB group (p = 0.016, OR 1.82, 95% CI 1.12-2.94). No difference in hyperkalemia frequency was found between them (p = 0.17). CONCLUSIONS: In patients with CKD, treatment with ACEI or ARB had a superior effect than no ACEI or ARB treatment on slowing kidney disease progression and on proteinuria reduction. Efficacy of ACEI and ARB was comparable. SN - 2235-3186 UR - https://www.unboundmedicine.com/medline/citation/31203280/Is_Chronic_Kidney_Disease_Progression_Influenced_by_the_Type_of_Renin_Angiotensin_System_Blocker_Used L2 - https://www.karger.com?DOI=10.1159/000500925 DB - PRIME DP - Unbound Medicine ER -