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Effect of Renin-Angiotensin-Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea.

ABSTRACT: Introduction:Conflicting results still exist regarding the benefit of renin-angiotensin-aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD). Methods:Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regression was applied for risk factor analysis with the cumulative duration of RAAS blockade use as time-varying covariate. The risks for mortality from all causes and major cardiovascular event-free survival were estimated. Results:Compared to the control group, patients in the RAAS group were younger but had a higher proportion of diabetes mellitus, had higher systolic blood pressure, required a greater number of prescribed antihypertensive drugs, and had a longer dialysis duration. On multivariate time-varying Cox regression analysis, the RAAS group with cumulative duration of >90 days was significantly associated with a lower risk of mortality from all causes after adjustment for confounding (hazard ratio [HR] = 0.45, 95% confidence interval [CI] = 0.35-0.58, P < 0.0001). Major cardiovascular event-free survival was also better for the RAAS group than for the control group on multivariate analysis (HR = 0.27, 95% CI = 0.20-0.37, P < 0.0001), considering the cumulative duration of RAAS blockade use. Conclusion:In Korean patients with ESRD, we reported a specific benefit of RAAS blockade in improving overall survival after adjustment for confounding factors from real-world data.

SUBMITTER: Yoo KD

PROVIDER: S-EPMC6224622 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Effect of Renin-Angiotensin-Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea.

Yoo Kyung Don KD Kim Clara Tammy CT Kim Yunmi Y Kim Hyo Jin HJ Park Jae Yoon JY Park Ji In JI Oh Yun Kyu YK Kang Shin-Wook SW Yang Chul Woo CW Kim Yong-Lim YL Kim Yon Su YS Lim Chun Soo CS Lee Jung Pyo JP

Kidney international reports 20180804 6

<h4>Introduction</h4>Conflicting results still exist regarding the benefit of renin-angiotensin-aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD).<h4>Methods</h4>Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regress ...[more]

PMID: 30450465

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Project description:BackgroundClinical practice guidelines recommend routine kidney function and serum potassium testing within 30 days of initiating ACE (angiotensin-converting enzyme) inhibitor or angiotensin II receptor blocker therapy. However, evidence is lacking about whether follow-up testing reduces therapy-related adverse outcomes.Methods and resultsWe conducted 2 population-based retrospective cohort studies in Kaiser Permanente Northern California and Ontario, Canada. Patients with outpatient serum creatinine and potassium tests in the 30 days after starting ACE inhibitor or angiotensin II receptor blocker therapy were matched 1:1 to patients without follow-up tests. We evaluated the association of follow-up testing with 30-day all-cause mortality and hospitalization with acute kidney injury or hyperkalemia using Cox regression. We also developed and externally validated a risk score to identify patients at risk of having abnormally high serum creatinine and potassium values in follow-up. We identified 75 251 matched pairs initiating ACE inhibitor or angiotensin II receptor blocker therapy between January 1, 2007, and December 31, 2017, in Kaiser Permanente Northern California. Follow-up testing was not significantly associated with 30-day all-cause mortality in Kaiser Permanente Northern California (hazard ratio, 0.75 [95% CI, 0.54-1.06]) and was associated with higher mortality in 84 905 matched pairs in Ontario (hazard ratio, 1.32 [95% CI, 1.07-1.62]). In Kaiser Permanente Northern California, follow-up testing was significantly associated with higher rates of hospitalization with acute kidney injury (hazard ratio, 1.66 [95% CI, 1.10-2.22]) and hyperkalemia (hazard ratio, 3.36 [95% CI, 1.08-10.41]), as was observed in Ontario. The risk score for abnormal potassium provided good discrimination (area under the curve [AUC], 0.75) and excellent calibration of predicted risks, while the risk score for abnormal serum creatinine provided moderate discrimination (AUC, 0.62) but excellent calibration.ConclusionsRoutine laboratory monitoring after ACE inhibitor or angiotensin II receptor blocker initiation was not associated with a lower risk of 30-day mortality. We identified patient subgroups in which targeted testing may be effective in identifying therapy-related changes in serum potassium or kidney function.

Dataset Information

Effect of Renin-Angiotensin-Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea.

Publications

Effect of Renin-Angiotensin-Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea.

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