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ACEI/ARB Rx Safe, Beneficial in Advanced Chronic Kidney Disease

Both ACEI/ARBs linked to lower risk for long-term dialysis, death with advanced kidney disease

MONDAY, Dec. 23, 2013 (HealthDay News) -- For patients with stable hypertension and advanced chronic kidney disease (CKD), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use is associated with renal benefits, according to a study published online Dec. 16 in JAMA Internal Medicine.

Ta-Wei Hsu, M.D., from the National Yang-Ming University Hospital in Ilan City, Taiwan, and colleagues assessed the effectiveness and safety of ACEI/ARB use for advanced predialysis CKD in 28,497 patients with hypertension. Both ACEI/ARB users (14,117 patients) and nonusers (14,380 patients) had serum creatinine levels >6 mg/dL, hematocrit levels <28 percent, and were treated with erythropoiesis-stimulating agents.

During a median follow-up of seven months, the researchers found that 70.7 percent of patients required long-term dialysis and 20.0 percent died before progression to end-stage renal disease necessitating dialysis. ACEI/ARB use correlated with a reduced risk of long-term dialysis (hazard ratio, 0.94) and the composite outcome of long-term dialysis or death (hazard ratio, 0.94). Across most patient subgroups, the renal benefit of ACEI/ARB use was consistent. The rate of hyperkalemia-associated hospitalization was increased for ACEI/ARB users versus nonusers, but there was no significant increase in the risk of predialysis mortality caused by hyperkalemia (hazard ratio, 1.03; P = 0.30).

"Patients with stable hypertension and advanced CKD who receive therapy with ACEIs/ARBs exhibit an association with lower risk for long-term dialysis or death by 6 percent," the authors conclude.

Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1787693#Abstract )Full Text (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1787693 )Editorial (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1787689 )