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ACE Inhibitor and Angiotensin Receptor Blocker Use and Mortality in Patients with Chronic Kidney Disease.
J Am Coll Cardiol. 2013 Nov 6;
Authors: Molnar MZ, Kalantar-Zadeh K, Lott EH, Lu JL, Malakauskas SM, Ma JZ, Quarles DL, Kovesdy CP
Abstract
OBJECTIVE: To assess the association between ACEI/ARB use and mortality in CKD patients.
BACKGROUND: There is insufficient evidence about the association of angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) with mortality in chronic kidney disease (CKD) patients.
METHODS: A logistic regression analysis was used to calculate the propensity of ACEI/ARB initiation in 141,413 US veterans with non-dialysis CKD 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 treatment weighing (IPTW) in "as-treated" analyses.
RESULTS: The mean±SD 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 significantly lower risk of mortality both in the intention-to-treat analysis (HR=0.81; 95%CI: 0.78-0.84, p<0.001) and in the as-treated analysis with IPTW (OR=0.37; 95%CI: 0.34-0.41, 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 non-dialysis dependent CKD patients, ACEI/ARB administration was associated with greater survival.
PMID: 24269363 [PubMed - as supplied by publisher]