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Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease : A Systematic Review and Retrospective Individual Participant-Level Meta-analysis of Clinical Trials.
- Source :
-
Annals of internal medicine [Ann Intern Med] 2024 Jul; Vol. 177 (7), pp. 953-963. Date of Electronic Publication: 2024 Jul 02. - Publication Year :
- 2024
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Abstract
- Background: In patients with advanced chronic kidney disease (CKD), the effects of initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) on the risk for kidney failure with replacement therapy (KFRT) and death remain unclear.<br />Purpose: To examine the association of ACEi or ARB treatment initiation, relative to a non-ACEi or ARB comparator, with rates of KFRT and death.<br />Data Sources: Ovid Medline and the Chronic Kidney Disease Epidemiology Collaboration Clinical Trials Consortium from 1946 through 31 December 2023.<br />Study Selection: Completed randomized controlled trials testing either an ACEi or an ARB versus a comparator (placebo or antihypertensive drugs other than ACEi or ARB) that included patients with a baseline estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m <superscript>2</superscript> .<br />Data Extraction: The primary outcome was KFRT, and the secondary outcome was death before KFRT. Analyses were done using Cox proportional hazards models according to the intention-to-treat principle. Prespecified subgroup analyses were done according to baseline age (<65 vs. ≥65 years), eGFR (<20 vs. ≥20 mL/min/1.73 m <superscript>2</superscript> ), albuminuria (urine albumin-creatinine ratio <300 vs. ≥300 mg/g), and history of diabetes.<br />Data Synthesis: A total of 1739 participants from 18 trials were included, with a mean age of 54.9 years and mean eGFR of 22.2 mL/min/1.73 m <superscript>2</superscript> , of whom 624 (35.9%) developed KFRT and 133 (7.6%) died during a median follow-up of 34 months (IQR, 19 to 40 months). Overall, ACEi or ARB treatment initiation led to lower risk for KFRT (adjusted hazard ratio, 0.66 [95% CI, 0.55 to 0.79]) but not death (hazard ratio, 0.86 [CI, 0.58 to 1.28]). There was no statistically significant interaction between ACEi or ARB treatment and age, eGFR, albuminuria, or diabetes ( P for interaction > 0.05 for all).<br />Limitation: Individual participant-level data for hyperkalemia or acute kidney injury were not available.<br />Conclusion: Initiation of ACEi or ARB therapy protects against KFRT, but not death, in people with advanced CKD.<br />Primary Funding Source: National Institutes of Health. (PROSPERO: CRD42022307589).<br />Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3236.
- Subjects :
- Humans
Glomerular Filtration Rate
Randomized Controlled Trials as Topic
Renal Replacement Therapy
Retrospective Studies
Angiotensin Receptor Antagonists therapeutic use
Angiotensin Receptor Antagonists adverse effects
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Renal Insufficiency, Chronic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1539-3704
- Volume :
- 177
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Annals of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 38950402
- Full Text :
- https://doi.org/10.7326/M23-3236