PS-C18-3: RENIN-ANGIOTENSIN SYSTEM INHIBITORS IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE ASSOCIATED WITH A LOWER RISK OF UNPLANNED DIALYSIS INITIATION

Abstract

Objective: Unplanned dialysis initiation is associated with poor outcomes. Whether patients with advanced chronic kidney disease (CKD) should receive renin-angiotensin system (RAS) inhibitors remains controversial. This study aimed to evaluate the effect of RAS inhibitors in patients with advanced CKD on the incidence of unplanned dialysis initiation. Furthermore, the association between RAS inhibitor therapy and the estimated glomerular filtration rate (eGFR) decline rate for 6 months before dialysis initiation was also investigated. Design and method: This single-center, retrospective study included patients who started maintenance dialysis at our hospital between April 2014 and March 2021. Patients who initiated dialysis within six months of nephrology referral or after kidney transplant were excluded. Unplanned dialysis initiation was defined as urgent hospitalization for starting dialysis or unexpectedly starting dialysis in the hospital for any purpose other than dialysis initiation. Missing values were handled with multiple imputations. Results: Among 334 patients (median age 70.0 [interquartile range 59.0–79.0] years; 28.4% females), 186 (55.7%) and 148 (44.3%) had a planned and unplanned dialysis initiation, respectively. Overall, 144 patients (43.1%) did not use, 51 (15.3%) stopped, 136 (40.7%) continued, and 3 (0.9%) started RAS inhibitors for 6 months before dialysis initiation. Multivariate logistic regression revealed that use of RAS inhibitors was significantly associated with a lower incidence of unplanned dialysis initiation (odds ratio [OR], 0.35; P < 0.01). Female sex (OR, 0.51; P < 0.05), use of potassium binders (OR, 0.25; P < 0.01), earlier referral to nephrology (OR, 0.45; P < 0.01), and earlier discussion of renal replacement therapy (OR, 0.35; P < 0.01) were also significantly associated with a lower incidence, whereas older age (OR, 1.25; P < 0.05), higher Charlson comorbidity index (OR, 1.34; P < 0.01) and faster decline in eGFR (OR, 1.29; P < 0.01) were associated with a higher risk of unplanned dialysis initiation. In multivariate linear regression to assess the rate of eGFR decline for 6 months before dialysis initiation, use of RAS inhibitors (β;, -4.2; P < 0.05) as well as older age (β;, -2.5; P < 0.01), higher geriatric nutritional risk index (β;, -2.9; P < 0.01) and use of bicarbonate (β;, -6.3; P < 0.01) was significantly associated with preserved kidney function. Conclusions: RAS inhibitor therapy in patients with advanced CKD was associated with a lower risk of unplanned dialysis initiation and preserved kidney function.