Abstract: SA-OR058

Association between Pre-ESRD RAAS Blockade and Post-ESRD Mortality

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Naseer, Adnan, VAMC, Germantown, Tennessee, United States
  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan
  • Riezenman, Ariel R, University of Tennessee Health Science Center - Memphis, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Gaipov, Abduzhappar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Renin-Angiotensin-Aldosterone system inhibitor (RAASi) use is associated with slower progression of chronic kidney disease (CKD) and lower mortality in patients with CKD. However, the association between pre-end stage renal disease (ESRD) RAASi use and post-ESRD mortality is unclear.

Methods

We examined 15,966 US veterans initiating dialysis during 2007-2014. We divided patients into three groups of RAASi use pattern in the last 3 pre-dialysis years: never exposed (n=7,294), exposed but discontinued in the last pre-dialysis year (n=6,833) and uninterrupted use (n=1,839). Associations of RAASi use patterns with all-cause mortality were examined in multivariable adjusted Cox models.

Results

Patients were 72±11 years old, 98% male, 23% African-American, and 65% diabetic. The all-cause mortality rates were 303 [95% CI 294-311]/1000 patient-years (PY) in patients never exposed to RAASi, 276 [95% CI 268-284]/1000PY in patients who discontinued RAASi and 240 [95% CI 227-254]/1000PY in patients on uninterrupted RAASi, respectively, during a median of 2.2 years of follow-up. Uninterrupted RAASi use was associated with lower risk of death after dialysis start in unadjusted and various adjusted analyses (Figure).

Conclusion

Uninterrupted RAASi use prior to dialysis is associated with lower risk of death after dialysis start. There was no post-ESRD survival benefit observed in patients who discontinued RAASi in the final year before MHD initiation.

Funding

  • NIDDK Support