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Antihypertensives associated with lower dialysis risk for patients with advanced CKD
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Patients with stable hypertension and the most advanced stage of chronic kidney disease before initiating dialysis appeared to have a lower risk for long-term dialysis or death if they were treated with the antihypertensive drugs known as angiotensin-converting enzyme inhibitors (ACE) or angiotensin II receptor blockers (ARBs), according to a study published by JAMA Internal Medicine, a JAMA Network publication.
An ACE inhibitor or ARB is known to delay the progression of CKD in patients with and without diabetes, particularly in those patients with mild to moderate renal insufficiency. But most large clinical trials of ACE inhibitors/ARB exclude patients with the most advanced stage of CKD pre-dialysis, perhaps out of concern that the drugs can cause renal failure and the need for dialysis, so it remains unclear whether that therapy is effective in patients with advanced CKD, according to the study background.
(Research shows association between ACE inhibitors, acute kidney injury)
Researchers in Taiwan examined the association between ACE inhibitor /ARB use and the risk of long-term dialysis and death in a nationwide group of 28,497 patients in a study by Ta-Wei Hsu, MD, of the National Yang-Ming University Hospital, and colleagues. The patients had the most advanced pre-dialysis stage of CKD, hypertension and anemia.
During a median follow-up of seven months, 20,152 patients (70.7 percent) required long-term dialysis and 5,696 (20 percent) died before progressing to ESRD (end-stage renal disease). Study findings indicate that treatment with ACEIs/ARBs in patients with stable hypertension and advanced CKD was associated with a lower risk for long-term dialysis or death by 6%.
(Combining blood pressure drugs linked to serious side effects in type 2 diabetes patients)
Commentary: An ACE in the hole for patients with advanced chronic kidney disease
In a related commentary, Meyeon Park, M.D., M.A.S., and Chi-yuan Hsu, M.D., M.Sc., of the University of California, San Francisco, write: "In the treatment of patients with advanced chronic kidney disease … a paramount goal is preventing or retarding progression to end-stage renal disease and the requirement of dialysis."
"However, the use of ACEIs or ARBs in advanced CKD remains uncertain. This important clinical question is the subject of a new study by Hsu and colleagues," the authors continue. "Overall, the study by Hsu and colleagues makes an important contribution to the literature."
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