Renin-angiotensin system inhibitors show more benefits in CKD vs calcium channel blockers
Patients with chronic kidney disease who were initiated on renin-angiotensin system inhibitors experienced greater benefits, including a reduced need for dialysis, than those initiated on calcium channel blockers.
According to Edouard L. Fu, BSc, of the department of clinical epidemiology at Leiden University Medical Center in the Netherlands, and colleagues, there is uncertainty regarding the “best” antihypertensive medications for patients with CKD stages G4 to 5 because they are often excluded from clinical trials.
“It is unknown whether initiating a renin-angiotensin system inhibitor (RASi) in patients with advanced chronic kidney disease (CKD) is superior to alternative antihypertensive agents such as calcium channel blockers (CCB),” the researchers wrote. “We compared the risks of kidney replacement therapy (KRT), mortality and major adverse cardiovascular events (MACE) in patients with advanced CKD in routine nephrology practice, initiating either RASi or CCB.”
The study included 4,803 patients identified through the Swedish Renal Registry. Participants had an eGFR of less than 30 mL/min/m2, except the control cohort which had CKD stage G3 with an eGFR of 30 mL/min/1.73m2 to 60 mL/min/1.73m2.
After a median follow-up of 4.1 years, researchers observed a significantly lower risk for KRT after new use of RASi compared with new use of CCB (adjusted HR = 0.79) for patients with CKD G4 to 5. Both groups had similar risks for mortality (aHR = 0.97) and MACE (aHR = 1).
Patients with CKD G3 on RASi experienced a similar risk reduction for KRT (aHR = 0.67) vs. CCB.
“These findings suggest that RASi initiation might slow the progression of kidney disease compared with CCB in patients with advanced CKD, and offer similar cardiovascular protection,” Fu and colleagues concluded.
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