Kidney Week

Abstract: TH-PO803

The Association of RAAS Blockade and the Progression of Residual Kidney Function Decline: A Nationwide Prospective Cohort Study

Session Information

• Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

• Kim, Yunmi, Dongguk University Gyeongju Hospital, Gyeongsangbuk-do, Korea (the Republic of)

Yunmi Kim,

• Yoo, Kyung Don, Dongguk University Gyeongju Hospital, Gyeongsangbuk-do, Korea (the Republic of)

Kyung Don Yoo,

• Kim, Clara Tammy, School of Public Health, Seoul National University, Seoul, Korea (the Republic of)

Clara Tammy Kim,

• Oh, Yun Kyu, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea (the Republic of)

Yun Kyu Oh,

• Kang, Shin-Wook, College of Medicine, BK21, Yonsei Univ., Seoul, Korea (the Republic of)

Shin-Wook Kang,

• Yang, Chul Woo, Seoul St. Mary's Hospital, Seoul, Korea (the Republic of)

Chul Woo Yang,

• Kim, Yong-Lim, Kyungpook National University Hospital, Daegu, Korea (the Republic of)

Yong-Lim Kim,

• Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Yon Su Kim,

• Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)

Chun Soo Lim,

• Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)

Jung Pyo Lee,

Background

Our aim was to evaluate the clinical effects of renin angiotensin aldosterone system (RAAS) blockade on residual renal function (RRF) in newly diagnosed patients with end-stage renal disease (ESRD) undergoing hemodialysis in Korea.

Methods

Total of 1,571 patients were enrolled in the Clinical Research Center for ESRD prospective observation cohort. RAAS treatment was defined as the use of angiotensin converting enzyme inhibitor or angiotensin receptor blocker for at least 3 months. RRF was defined using 24-hour urine volume and Creatinine Clearance measured at 0, 3 and 12 months after dialysis initiation.

Results

The 671 patients (43%) were in the RAAS group. The RAAS and control groups were comparable in terms of age, sex, primary renal disease, comorbidities, and dialysis dose including Kt/V, ultrafiltration volume per session. The development of total anuria at 12 months was similar in both groups (39.3% vs. 41.1%, RAAS group vs. control group).
The RRF in both group decreased over a 12-month period. After adjustment for age, sex, diabetes history, blood pressure and ultrafiltration volume, use of RAAS did not provide a significant protective effect on RRF preservation (Odds ratio 0.57 95% CI 0.31-1.04, p=0.069). Mixed effect linear regression revealed no significant difference in the course of residual renal function between RAAS group and control group (p value=0.127). In subgroup analysis for patients with completely followed-up cases, patients using RAAS over 12 months did not significantly lower the RRF than other patients(p value=0.388).

Conclusion

In Korean patients with ESRD, RAAS blockade failed to clarify the protective effect for RRF. Further research is needed to provide optimal treatment for preservation of RRF, especially in Korean patients with incident dialysis.

Funding

• Government Support - Non-U.S.