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J Am Coll Cardiol. 2014 Feb 25;63(7):650-658. doi: 10.1016/j.jacc.2013.10.050. Epub 2013 Nov 21.

Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker use, and mortality in patients with chronic kidney disease.

Author information

1
Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine Medical Center, Irvine, California; Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California.
2
Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine Medical Center, Irvine, California; Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California.
3
VA Informatics and Computing Infrastructure, Salt Lake City, Utah.
4
Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
5
Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia; Division of Nephrology, University of Virginia, Charlottesville, Virginia.
6
Division of Nephrology, University of Virginia, Charlottesville, Virginia.
7
Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. Electronic address: csaba.kovesdy@va.gov.

Abstract

OBJECTIVES:

The study objective was to assess the association between angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use and mortality in patients with chronic kidney disease (CKD).

BACKGROUND:

There is insufficient evidence about the association of ACEI or ARBs with mortality in patients with CKD.

METHODS:

A logistic regression analysis was used to calculate the propensity of ACEI/ARB initiation in 141,413 U.S. veterans with nondialysis CKD who were previously unexposed to ACEI/ARB treatment. We examined the association of ACEI/ARB administration with all-cause mortality in patients matched by propensity scores using the Kaplan-Meier method and Cox models in "intention-to-treat" analyses and in generalized linear models with binary outcomes and inverse probability of treatment weights in "as-treated" analyses.

RESULTS:

The age of the patients at baseline was 75 ± 10 years, 8% of patients were black, and 22% were diabetic. ACEI/ARB administration was associated with a significantly lower risk of mortality both in the intention-to-treat analysis (hazard ratio: 0.81, 95% confidence interval: 0.78 to 0.84; p < 0.001) and the as-treated analysis with inverse probability of treatment weights (odds ratio: 0.37, 95% confidence interval: 0.34 to 0.41; p < 0.001). The association of ACEI/ARB treatment with lower risk of mortality was present in all examined subgroups.

CONCLUSIONS:

In this large contemporary cohort of nondialysis-dependent patients with CKD, ACEI/ARB administration was associated with greater survival.

KEYWORDS:

angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; chronic kidney disease; mortality

PMID:
24269363
PMCID:
PMC3944089
DOI:
10.1016/j.jacc.2013.10.050
[Indexed for MEDLINE]
Free PMC Article

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