Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial

Kjærgaard, Krista Dybtved; Peters, Christian Daugaard; Jespersen, Bente; Tietze, I. N.; Madsen, Jonas Stenløkke; Pedersen, Bjørn Panyella; Novosel, Marija Kristina; Laursen, Kathrine Skaaning; Bibby, Bo Martin; Strandhave, Charlotte; Jensen, Jens Dam

doi:10.1053/j.ajkd.2014.05.011

Cited by 31 publications

(40 citation statements)

References 13 publications

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“…Recently, some investigators reported that the initial HD therapy affected the effect of RAAS blockade on RRF. Xydakis et al [121] showed in a 1-year randomized controlled open-label study of 42 HD patients that ACEI treatment (with enalapril) was associated with a significantly greater preservation of residual GFR and urine volume, while in another randomized, placebo-controlled study, ARB therapy (with irbesartan) did not achieve any beneficial results [122] . Since blockage of the renin-angiotensin system may increase the risk of intradialytic hypotensive episodes, which possibly causes ischemia-induced kidney damage, additional studies are required to test these medications in HD patients.…”

Section: Renin-angiotensin-aldosterone System Blockade and Blood Presmentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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Background: Residual renal function (RRF), defined as the ability of native kidneys to eliminate water and uremic toxins, is closely correlated with mortality and morbidity rates among patients receiving either peritoneal dialysis (PD) or hemodialysis (HD) via continuous clearance of middle-sized molecules and protein-bound solutes. Therefore, preserving RRF is considered to be one of the primary goals in managing patients with end-stage renal disease (ESRD). Summary and Key Messages: In this article, we provide a review on the understanding and management of RRF in patients on dialysis. RRF may be estimated and measured by calculating the mean 24-hour urine creatinine level and urea clearance. Currently, several middle-sized molecules are reported but rarely used in practice. Many risk factors such as original renal diseases, dietary intake, and nephrotoxic agents impair RRF. Targeting such factors may halt the decline in RRF and offer better outcomes for patients on PD or HD. Except for in PD patients, RRF is a powerful predictor of survival in HD patients. RRF requires more clinical and research attention in the care of patients with ESRD on dialysis.

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Section: Renin-angiotensin-aldosterone System Blockade and Blood Presmentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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“…A possible mechanism of action might be in the putative ability of ACEIs/ARBs to preserve residual renal function in patients on PD, since residual renal function has been consistently linked to better outcomes [13,14,[17][18][19][20][21][22]. While there are limited data showing that ACEIs/ARBs might similarly preserve residual renal function in patients on hemodialysis, the effect on CV outcomes might be limited in the hemodialysis population since they lose their residual renal function sooner than those on PD [46][47][48]. An alternative explanation is that ACEIs/ARBs may help preserve the peritoneal membrane, providing better ultrafiltration and improved CV function [49].…”

Section: Table1 Continuedmentioning

confidence: 99%

Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and cardiovascular outcomes in patients initiating peritoneal dialysis

Shen

Saxena

Montez‐Rath

et al. 2016

Nephrol. Dial. Transplant.

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A B S T R A C TBackground: Data on the effectiveness of angiotensinconverting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in reducing cardiovascular (CV) risk in patients undergoing peritoneal dialysis (PD) are limited. We investigated the association between ACEI/ARB use and CV outcomes in patients initiating PD. Methods: In this observational cohort study, we identified from the United States Renal Data System all adult patients who initiated PD from 2007 to 2011 and participated in Medicare Part D, a federal prescription drug benefits program, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users. We applied Cox regression to an inverse probability of treatment weighted cohort to estimate the hazard ratios (HRs) for the combined outcome of death, ischemic stroke or myocardial infarction (MI) and each outcome individually. Results: Among 4879 patients, 2063 (42%) used an ACEI/ARB. Patients were followed up for a median of 1.2 years. We recorded 1771 events, for a composite rate of 25 events per 100 person-years. ACEI/ARB use (versus nonuse) was associated with a reduced risk of the composite outcome {HR 0.84 [95% confidence interval (CI) 0.76-0.93]}, all-cause mortality ] and CV death ], but not MI )] or ischemic stroke [HR 1.06 (95% CI 0.79-1.43)]. Results were similar in astreated analyses. In a subgroup analysis, we did not find any effect modification by residual renal function. Conclusions: ACEI/ARB use is common in patients initiating PD and is associated with a lower risk of fatal CV outcomes.

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“…1). A total of 11 relevant RCTs with 1856 patients were included for further analysis [8–11, 14–20]. The characteristics of the included studies are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, most trials excluded patients with end stage renal disease (ESRD) receiving maintenance dialysis, the beneficial effects of ACEI/ARBs on CVEs and RRF in dialysis patients remain uncertain. Some large-scale trials tested the effects of ACEIs/ARBs therapy in dialysis patients provided inconsistent results, and much uncertainty persists regarding the protective effects of this agent [8–11]. …”

Section: Introductionmentioning

confidence: 99%

Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials

Liu

Zheng

et al. 2017

BMC Nephrol

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BackgroundThe role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reducing risk of cardiovascular events (CVEs) and preserving kidney function in patients with chronic kidney disease is well-documented. However, the efficacy and safety of these agents in dialysis patients is still a controversial issue.MethodsWe systematically searched MEDLINE, Embase, Cochrane Library and Wanfang for randomized trials. The relative risk (RR) reductions were calculated with a random-effects model. Major cardiovascular events, changes in GFR and drug-related adverse events were analyzed.ResultsEleven trials included 1856 participants who were receiving dialysis therapy. Compared with placebo or other active agents groups, ARB therapy reduced the risk of heart failure events by 33% (RR 0.67, 95% CI 0.47 to 0.93) with similar decrement in blood pressure in dialysis patients. Indirect comparison suggested that fewer cardiovascular events happened during treatment with ARB (0.77, 0.63 to 0.94). The results indicated no significant differences between the two treatment regimens with regard to frequency of myocardial infarction (1.0, 0.45 to 2.22), stroke (1.16, 0.69 to 1.96), cardiovascular death (0.89, 0.64 to 1.26) and all-cause mortality (0.94, 0.75 to 1.17). Five studies reported the renoprotective effect and revealed that ACEI/ARB therapy significantly slowed the rate of decline in both residual renal function (MD 0.93 mL/min/1.73 m2, 0.38 to 1.47 mL/min/1.73 m2) and urine volume (MD 167 ml, 95% CI 21 ml to 357 ml). No difference in drug-related adverse events was observed in both treatment groups.ConclusionsThis study demonstrates that ACE-Is/ARBs therapy decreases the loss of residual renal function, mainly for patients with peritoneal dialysis. Overall, ACE-Is and ARBs do not reduce cardiovascular events in dialysis patients, however, treatment with ARB seems to reduce cardiovascular events including heart failure. ACE-Is and ARBs do not induce an extra risk of side effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0605-7) contains supplementary material, which is available to authorized users.

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Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial

Cited by 31 publications

References 13 publications

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and cardiovascular outcomes in patients initiating peritoneal dialysis

Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials

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