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Int J Cardiol. 2018 Sep 1;266:180-186. doi: 10.1016/j.ijcard.2018.03.016.

Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure.

Author information

1
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
2
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. Electronic address: scchae@knu.ac.kr.
3
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
4
Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
5
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
6
Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
7
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
8
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
9
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
10
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
11
Department of Internal Medicine, Heart Research Center of Chonnam National University, Gwangju, Republic of Korea.
12
Division of Cardiovascular and Rare Diseases, National Institute of Health, Osong, Republic of Korea.

Abstract

BACKGROUND:

Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure.

METHODS AND RESULTS:

Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40% and estimated glomerular filtration rate < 30 mL/min/1.73 m2 during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6%) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7% and 53.8% for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269-0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731-1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005).

CONCLUSIONS:

Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.

KEYWORDS:

Angiotensin receptor blocker; Angiotensin-converting enzyme inhibitors; Heart failure; Renal insufficiency

PMID:
29887444
DOI:
10.1016/j.ijcard.2018.03.016
[Indexed for MEDLINE]

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