Longer predialysis ACEi/ARB exposure lowers postdialysis mortality

Longer predialysis use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARB) results in reduced postdialysis mortality, reveals a study.

“ACEi/ARB improve predialysis outcomes,” the investigators said. “[H]owever, ACEi/ARB are underused in patients transitioning to dialysis.”

To determine the association of different patterns of predialysis ACEi/ARB use with postdialysis survival and whether potentially modifiable adverse events are associated with lower predialysis ACEi/ARB use, a cohort study was performed on 34,676 US veterans with and 10,690 without ACEi/ARB exposure in the 3-year predialysis period who then transitioned to dialysis between 2007 and 2014.

Multivariable-adjusted regression analyses were then carried out to examine the associations of different patterns of predialysis ACEi/ARB use with postdialysis all-cause mortality and with predialysis acute kidney injury and hyperkalaemia events. Participants had a mean age of 70 years, of whom 98 percent were males and 27 percent were African Americans.

Continuous use of ACEI/ARB vs nonuse correlated with reduced postdialysis all-cause mortality (adjusted hazard ratio [aHR], 0.87, 95 percent confidence interval [CI], 0.83–0.92).

Likewise, analyses modeling the duration of predialysis ACEi/ARB use showed that ACEi/ARB use of 50–74 percent (aHR, 0.96, 95 percent CI, 0.92–0.99) and ≥75 percent (aHR, 0.91, 95 percent CI, 0.88–0.94) correlated with lower mortality compared to nonuse. Conversely, shorter predialysis use of ACEi/ARB did not increase postdialysis survival.

Furthermore, shorter duration (<50 percent) of ACEi/ARB use correlated with predialysis acute kidney injury, while interrupted and ACEi/ARB use <75 percent correlated with hyperkalaemia.

“Prospective studies are needed to evaluate the benefits of strategies enabling uninterrupted predialysis ACEi/ARB use,” the investigators said.