ACEI/ARB may provide renoprotective effect

Patients with stable hypertension and advanced chronic kidney disease (CKD) who take medications that block the renin-angiotensin-aldosterone system may be less likely to need long-term dialysis than similar patients not treated with these drugs. Their risk of death also may be lower, according to study published online Dec. 16 in JAMA Internal Medicine.

Ta-Wei Hsu, MD, of the National Health Research Institutes in Miaoli County, Taiwan, and colleagues evaluated data from 28,497 adults with hypertension and CKD between 2000 and 2009. They determined the association between ACEI/ARB and the start of long-term dialysis or death, whichever outcome came first. All patients had creatinine levels of greater than 6 percent, hematocrit levels of less than 28 percent and were all under treatment with erythropoiesis-stimulating agents (ESAs) for anemia. The participants were grouped into either ACEI/ARB users or ACEI/ARB nonusers.

After an average follow-up period of seven months, 70.7 percent of patients needed long-term dialysis and 20 percent died before needing dialysis. Patients in the ACEI/ARB group had a lower risk of needing long-term dialysis (hazard ratio [HR] 0.94) and the combined outcome of long-term dialysis or death (HR 0.94). All patient subpopulations saw the same benefits from the drug combination. Treatment with either ACEI or ARB was also renoprotective.

However, participants in the ACEI/ARB group were more often hospitalized because of hyperkalemia, but their high potassium levels were not related to an increased risk of death.

Although the study was observational and included only participants who received ESAs, the investigators argued that their findings support the use of ACEI/ARB in patients with CKD that ultimately becomes early end-stage renal disease (ESRD).

“In such a condition, withholding ACEI/ARB therapy is unwarranted and may hasten the onset of ESRD,” they wrote.