Renin Angiotensin Aldosterone System Blockades Does Not Protect Residual Renal Function in Patients with Hemodialysis at 1 Year After Dialysis Initiation: A Prospective Observational Cohort Study

Kyung Don Yoo,Yon Su Kim,Jeonghwan Lee,Chul Woo Yang,Clara Tammy Kim,Jung Pyo Lee,Yong-Lim Kim,Yun Kyu Oh,Soie Kwon,Shin-Wook Kang,Chun Soo Lim

doi:10.1038/s41598-019-54572-6

Abstract

The beneficial effects of renin angiotensin aldosterone system (RAAS) blockade on residual renal function (RRF) in patients who have just initiated hemodialysis (HD) have been inconclusive. In this study, 935 patients with incident HD from a nationwide prospective observational cohort in Korea were included for analysis. The primary outcome showed that RRF as demonstrated by urine volume changes over 0, 3, and 12 months differed between the RAAS blockade and control groups. Mixed-effects linear regression was used to compare RRF between the groups. Patients in the RAAS group had a greater proportion of higher urine volume at study enrollment compared to the control group, but there was no difference in baseline characteristics, heart function, and dialysis-related indices. After adjusting for confounding factors, the RAAS group did not provide a significant benefit to RRF in a mixed-effects linear regression (p = 0.51). Male gender, high Charlson comorbidity index, diuretic use, and high weekly ultrafiltration volume were associated with faster decline in RRF. The RAAS group failed to provide a protective effect for the development of anuria 1 year after initiating dialysis based on the multivariate logistic regression (OR 0.73 95% CI 0.25–2.13, p = 0.57). In Korean patients with incident HD, RAAS blockade did not provide a protective effect for RRF after 1 year. Further research is needed to clarify the optimal treatment for preserving RRF in HD patients.

Highlights

The beneficial effects of renin angiotensin aldosterone system (RAAS) blockade on residual renal function (RRF) in patients who have just initiated hemodialysis (HD) have been inconclusive
The primary outcome showed that RRF as demonstrated by urine volume changes over 0, 3, and 12 months differed between the RAAS blockade and control groups
Patients in the control group used a greater number of diuretics for volume control (49.8% in the RAAS group vs. 57.1% in the control group; p = 0.02), and on the contrary, patients in the RAAS group used a greater number of calcium channel blockers (66.7% in the RAAS group vs. 60.9% in the control group, respectively; p = 0.07)

Summary

Introduction

The beneficial effects of renin angiotensin aldosterone system (RAAS) blockade on residual renal function (RRF) in patients who have just initiated hemodialysis (HD) have been inconclusive. Preserved kidney function offers HD patients several advantages, such as a lower dialysis dose, more liberal diet intake, and a lower ultrafiltration rate per dialysis session[4,5,6] Despite these www.nature.com/scientificreports benefits, there are few data on HD patients compared to peritoneal dialysis patients[7], so the importance of RRF has increased in HD patients[8]. An observational study of newly started HD patients from the US Renal Data System database found a protective effect of RAAS blockade on the decline of RRF, as defined by urine volume, by Moist et al.[13].

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