User of angiotensin-converting-enzyme inhibitor and/or angiotensin II receptor blocker might be associated with vascular calcification in predialysis chronic kidney disease patients: a retrospective single-center observational study

Abstract

Background Vascular calcification is a prominent feature in chronic kidney disease (CKD) and diabetes mellitus. A recent report suggests that angiotensin II is protective to vascular calcification. Therefore, we investigated the relationship between vascular calcification and use of angiotensin-converting-enzyme inhibitor (ACEI) and/or angiotensin II receptor blocker (ARB) from a cross-sectional view. Methods A total of 121 predialysis CKD patients (age 71 ± 12 y; male 72; estimated glomerular filtration rate (eGFR) 20.2 (11.8 - 40.3) mL/min/1.73 m2) who underwent thoracoabdominal plain computed tomography scan were included in this study. The total vascular calcification volume (Calc) was calculated with a three-dimensional imaging software and standardized by body surface area (BSA). The relevance between log [Calc/BSA] and ACEI/ARB use was investigated by multivariate linear regression analyses with or without a time-duration factor of ACEI/ARB use. Results The Calc/BSA was 5.62 (2.01 - 12.7) mL/m2 in 121 patients. In multivariate analyses adjusted with age, sex, ACEI/ARB and log [eGFR], ACEI/ARB use is significantly and positively associated with log [Calc/BSA] (β = 0.2781, p = 0.0007). Even after the adjustment by age, sex, log [eGFR], phosphate, diabetes mellitus, systolic blood pressure, warfarin, hypertension, dyslipidemia, low-density lipoprotein cholesterol, diuretics and ACEI/ARB, ACEI/ARB use is significantly and positively associated with log [Calc/BSA] (β = 0.1677, p = 0.0487). When 90 patients whose time-duration of ACEI/ARB use was clear in medical records were studied, a multivariate analysis adjusted with age, sex, log [eGFR], and ACEI/ARB duration factors showed that the longer use of ACEI/ARB more than 2 years was significantly, independently and positively associated with log [Calc/BSA] (β = 0.2864, p = 0.0060). Conclusions ACEI/ARB user was associated with vascular calcification in predialysis patients with low eGFR. Prospective studies with larger numbers of patients or more in vitro studies are needed to confirm whether this phenomenon is due to the use of ACEI/ARB itself, the underlying disease condition or the prescription bias.

Vascular calcification: Molecular mechanisms and therapeutic interventions

“…The result has proved that angiotensin‐converting enzyme inhibitor (ACEI)/angiotensin‐receptor blocker (ARB) user is significantly and positively associated with low eGFR. 242 The available intravascular ultrasonography studies on coronary arteries have proved that ARB such as olmesartan and telmisartan exerted a significant effect on plaque regression; however, the use of ACEI did not demonstrate such an effect. 243 Notwithstanding these clinical data, the effect of ACEI/ARB on VC is still less clear.…”

“…A total of 121 predialysis CKD patients (age 71 ± 12 years; male 72 with eGFR 20.2 (11.8–40.3) ml/min/1.73 m 2 ) who underwent thoracoabdominal plain computed tomography scan were enrolled in this study. The result has proved that angiotensin‐converting enzyme inhibitor (ACEI)/angiotensin‐receptor blocker (ARB) user is significantly and positively associated with low eGFR 242 . The available intravascular ultrasonography studies on coronary arteries have proved that ARB such as olmesartan and telmisartan exerted a significant effect on plaque regression; however, the use of ACEI did not demonstrate such an effect 243 .…”