Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker use, and mortality in patients with chronic kidney disease

Miklos Z. Molnar, Kamyar Kalantar-Zadeh, Evan H. Lott, Jun Ling Lu, Sandra M. Malakauskas, Jennie Z. Ma, Darryl L. Quarles, Csaba P. Kovesdy

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Objectives The study objective was to assess the association between angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use and mortality in patients with chronic kidney disease (CKD). Background There is insufficient evidence about the association of ACEI or ARBs with mortality in patients with CKD. Methods A logistic regression analysis was used to calculate the propensity of ACEI/ARB initiation in 141,413 U.S. veterans with nondialysis CKD who were 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 of treatment weights in "as-treated" analyses. Results The 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 a significantly lower risk of mortality both in the intention-to-treat analysis (hazard ratio: 0.81, 95% confidence interval: 0.78 to 0.84; p < 0.001) and the as-treated analysis with inverse probability of treatment weights (odds ratio: 0.37, 95% confidence interval: 0.34 to 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 nondialysis-dependent patients with CKD, ACEI/ARB administration was associated with greater survival.

Original languageEnglish
Pages (from-to)650-658
Number of pages9
JournalJournal of the American College of Cardiology
Volume63
Issue number7
DOIs
Publication statusPublished - Feb 25 2014

Keywords

  • angiotensin receptor blockers
  • angiotensin-converting enzyme inhibitors
  • chronic kidney disease
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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