ACEI/ARB Rx Safe, Beneficial in Advanced Chronic Kidney Disease
(HealthDay News) – For patients with stable hypertension and advanced chronic kidney disease (CKD), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use is associated with renal benefits, according to a study published online Dec. 16 in JAMA Internal Medicine.
Ta-Wei Hsu, MD, from the National Yang-Ming University Hospital in Ilan City, Taiwan, and colleagues assessed the effectiveness and safety of ACEI/ARB use for advanced predialysis CKD in 28,497 patients with hypertension. Both ACEI/ARB users (14,117 patients) and nonusers (14,380 patients) had serum creatinine levels >6mg/dL, hematocrit levels <28%, and were treated with erythropoiesis-stimulating agents.
During a median follow-up of seven months, the researchers found that 70.7% of patients required long-term dialysis and 20.0% died before progression to end-stage renal disease necessitating dialysis. ACEI/ARB use correlated with a reduced risk of long-term dialysis (hazard ratio, 0.94) and the composite outcome of long-term dialysis or death (hazard ratio, 0.94). Across most patient subgroups, the renal benefit of ACEI/ARB use was consistent. The rate of hyperkalemia-associated hospitalization was increased for ACEI/ARB users vs. nonusers, but there was no significant increase in the risk of predialysis mortality caused by hyperkalemia (hazard ratio, 1.03; P=0.30).
"Patients with stable hypertension and advanced CKD who receive therapy with ACEIs/ARBs exhibit an association with lower risk for long-term dialysis or death by 6%," the authors conclude.