Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population

Cai Mei Zheng ,Jin Shuen Chen ,Tzu Ting Chen ,Jia Yi Wang ,Yu Yang,Hung Yi Chiou ,Sui-Lung Su,Jun Zheng ,Yi Wu ,Nain-Feng Chu,Hsin Ting Lin ,Ming Cheng Wang ,Tsu‐Chung Chang ,Shang Jyh Hwang ,Chien Te Lee ,Mei Yi Wu ,Yanwei Lin ,Kuo Cheng Lu ,Yung Ho Hsu ,Senyeong Kao,Fung Chang Sung ,Yungang Wu ,Sheng Po Chiu ,Yuh Feng Lin

doi:10.1038/s41598-019-38991-z

Abstract

It remains unclear how different uses of angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) influence the progression of chronic kidney disease (CKD). This study explored CKD progression in a multicentre, longitudinal cohort study that included 2639 patients with CKD stage 1–5 and hypertension. Patients treated with ACEI or ARB for ≥90 days during a 6-mo period comprised the study group, or no treatment, comprised the control group. The study group was subdivided on the basis of treatment: ACEI monotherapy or ARB monotherapy. Progression of renal deterioration was defined by an average eGFR decline of more than 5 mL/min/1.73 m2/yr or the commencement of dialysis. With at least 1-year follow up, a progression of renal deterioration was demonstrated in 29.70% of the control group and 25.09% of the study group. Patients in the study group had significantly reduced progression of CKD with adjusted odds ratio 0.79 (95% confidence interval: 0.63–0.99). However, when ACEI monotherapy and ARB monotherapy were analyzed separately, none of their associations with CKD progression was statistically significant. In conclusion, ACEI or ARB monotherapy may retard the deterioration of renal function among patients with CKD and hypertension.

Highlights

It remains unclear how different uses of angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) influence the progression of chronic kidney disease (CKD)
Given the uncertainties concerning the efficacy of ACEI or ARB treatment to slow the rapid progression of renal function, we conducted a study on a large multi-center cohort comprised of a Taiwanese population using the National Health Insurance Database in Taiwan, and examined the influence of ACEI monotherapy or ARB monotherapy on renal disease progression among patients with CKD and hypertension
The control group tended to be older, to be more likely with previous diabetes mellitus (DM), to have a lower baseline eGFR, waist, BMI, serum K, Hb, and Hct, to have higher baseline triglyceride and serum phosphate level, and to be less likely to treat with an ACEI or ARB within 1 year prior to the index date compared with the study group

Summary

Introduction

It remains unclear how different uses of angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) influence the progression of chronic kidney disease (CKD). The MDRD Study 5 discovered that a reduction of proteinuria independently slowed the rate of GFR decline and that the renoprotective effect from lowering blood pressure depended on the level of proteinuria Among antihypertensive agents, both angiotensin-converting enzyme (ACE) inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) demonstrated a renoprotective effect attributable to both antihypertensive and antiproteinuric effects[5,6,7]. Given the uncertainties concerning the efficacy of ACEI or ARB treatment to slow the rapid progression of renal function, we conducted a study on a large multi-center cohort comprised of a Taiwanese population using the National Health Insurance Database in Taiwan, and examined the influence of ACEI monotherapy or ARB monotherapy on renal disease progression among patients with CKD and hypertension

Methods

Results

Conclusion