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Longer predialysis ACEi/ARB exposure lowers postdialysis mortality

06 Sep 2020

Longer predialysis use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARB) results in reduced postdialysis mortality, reveals a study.

“ACEi/ARB improve predialysis outcomes,” the investigators said. “[H]owever, ACEi/ARB are underused in patients transitioning to dialysis.”

To determine the association of different patterns of predialysis ACEi/ARB use with postdialysis survival and whether potentially modifiable adverse events are associated with lower predialysis ACEi/ARB use, a cohort study was performed on 34,676 US veterans with and 10,690 without ACEi/ARB exposure in the 3-year predialysis period who then transitioned to dialysis between 2007 and 2014.

Multivariable-adjusted regression analyses were then carried out to examine the associations of different patterns of predialysis ACEi/ARB use with postdialysis all-cause mortality and with predialysis acute kidney injury and hyperkalaemia events. Participants had a mean age of 70 years, of whom 98 percent were males and 27 percent were African Americans.

Continuous use of ACEI/ARB vs nonuse correlated with reduced postdialysis all-cause mortality (adjusted hazard ratio [aHR], 0.87, 95 percent confidence interval [CI], 0.83–0.92).

Likewise, analyses modeling the duration of predialysis ACEi/ARB use showed that ACEi/ARB use of 50–74 percent (aHR, 0.96, 95 percent CI, 0.92–0.99) and ≥75 percent (aHR, 0.91, 95 percent CI, 0.88–0.94) correlated with lower mortality compared to nonuse. Conversely, shorter predialysis use of ACEi/ARB did not increase postdialysis survival.

Furthermore, shorter duration (<50 percent) of ACEi/ARB use correlated with predialysis acute kidney injury, while interrupted and ACEi/ARB use <75 percent correlated with hyperkalaemia.

“Prospective studies are needed to evaluate the benefits of strategies enabling uninterrupted predialysis ACEi/ARB use,” the investigators said.

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Most Read Articles
Jairia Dela Cruz, 2 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
11 Sep 2020
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06 Sep 2020
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4 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.