Abstract: FR-PO404

Complications of RAAS Blockade in Patients with Advanced CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., 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
  • Wall, Barry M., Veterans Affairs Medical Center, 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
Background

Renin-Angiotensin-Aldosterone system inhibitors (RAASi) are associated with slower progression of chronic kidney disease (CKD) and lower mortality in patients with CKD, yet their discontinuation is frequent. The reasons for not using or for stopping RAASi in patients with advanced CKD are unclear.

Methods

We examined 15,966 US veterans initiating dialysis during 2007-2014, who displayed three RAASi use patterns in the last 3 years pre-dialysis: 1) never used (n=7,294), 2) discontinued in the last year before dialysis (n=6,833) and 3) uninterrupted use (n=1,839). We defined AKI as a >25% decrease in eGFR and hyperkalemia as a potassium >5.5 mmol/l during the 3 years prior to dialysis. Associations of RAASi use patterns with incidence of AKI and hyperkalemia were examined in logistic regression models adjusted for demographics, comorbidities, blood pressure and eGFR.

Results

Patients were 72±11 years old, 98% male, 23% African-American, and 65% diabetic. Compared to patients who never used RAASi, uninterrupted and interrupted RAASi use were associated with 16% and 32% higher multivariable adjusted risk of AKI [Figure Panel A], and with 11% and 81% higher multivariable adjusted risk of hyperkalemia [Figure Panel B], respectively.

Conclusion

RAASi before dialysis is associated with higher risk of AKI and hyperkalemia. These complications (especially hyperkalemia) may contribute to the discontinuation of RAASi in patients with advanced CKD. Additional studies are needed to determine if measures aimed at alleviating hyperkalemia and AKI could lead to higher RAASi use and improved outcomes.

Funding

  • NIDDK Support