Antihypertensives associated with lower dialysis risk for patients with advanced CKD

December 16, 2013

Patients with stable hypertension and the most advanced stage of chronic kidney disease (CKD) before dialysis appeared to have a lower risk for long-term dialysis or death if they were treated with the antihypertensive drugs known as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), according to a study published by JAMA Internal Medicine.

An ACEI or ARB is known to delay the progression of CKD in with and without diabetes, particularly in those patients with mild to moderate . But most large clinical trials of ACEI/ARB exclude patients with the most of CKD predialysis, perhaps out of concern that the drugs can cause renal failure and the need for dialysis, so it remains unclear whether that therapy is effective in patients with advanced CKD, according to the study background.

Researchers in Taiwan examined the association between ACEI/ARB use and the risk of long-term dialysis and death in a nationwide group of 28,497 patients in a study by Ta-Wei Hsu, M.D., of the National Yang-Ming University Hospital, and colleagues. The patients had the most advanced predialysis stage of CKD, hypertension and anemia.

During a median follow-up of seven months, 20,152 patients (70.7 percent) required long-term dialysis and 5,696 (20 percent) died before progressing to ESRD (end-stage ). Study findings indicate that treatment with ACEIs/ARBs in patients with stable and advanced CKD was associated with a lower risk for long-term dialysis or death by 6 percent.

"In conclusion, our findings expand the existing knowledge in the field and provide clinicians with new information," the authors conclude.

In a related commentary, Meyeon Park, M.D., M.A.S., and Chi-yuan Hsu, M.D., M.Sc., of the University of California, San Francisco, write: "In the treatment of patients with advanced (CKD) … a paramount goal is preventing or retarding progression to end-stage renal disease and the requirement of dialysis."

"However, the use of ACEIs or ARBs in advanced CKD remains uncertain. This important clinical question is the subject of a new study by Hsu and colleagues," the authors continue. "Overall, the study by Hsu and colleagues makes an important contribution to the literature."

Explore further: Healthy diet, moderate alcohol linked with decreased risk of kidney disease in patient with diabetes

More information: JAMA Intern Med. Published online December 16, 2013. DOI: 10.1001/jamainternmed.2013.12700
JAMA Intern Med. Published online December 16, 2013. DOI: 10.1001/jamainternmed.2013.12176

Related Stories

New innovations in clinical science

November 9, 2013

A variety of recent studies highlight new and innovative research efforts that could help improve individuals' kidney health. Below are the findings of some of these studies, which are being presented at ASN Kidney Week 2013 ...

Wider statin use recommended for chronic kidney disease

December 10, 2013

(HealthDay)—New guidelines for lipid management in chronic kidney disease (CKD) recommend wider statin use, according to a clinical practice guideline published online Dec. 10 in the Annals of Internal Medicine.

Recommended for you

Cellphone data can track infectious diseases

August 20, 2015

Tracking mobile phone data is often associated with privacy issues, but these vast datasets could be the key to understanding how infectious diseases are spread seasonally, according to a study published in the Proceedings ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.