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Kidney Week

Abstract: PO0442

Renin-Angiotensin-Aldosterone System (RAAS) Blockade Does Not Affect Kidney Progression in Patients with CKD Without Diabetes and Without Proteinuria

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Chang, Shirley Shwu-Shiow, Erie County Medical Center, Buffalo, New York, United States
  • Jalal, Kabir, University at Buffalo - The State University of New York, Buffalo, New York, United States
  • Charest, Andre F., Erie County Medical Center, Buffalo, New York, United States
Background

Non-proteinuric CKD contributes to about 80% of end stage kidney disease and is poorly studied in terms of risk factors & pathogenesis. RAAS blockers such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been shown to be renoprotective in CKD progression in patients with diabetes and proteinuria. There is a paucity of data on effect of ACEI/ARB in non-diabetic non-proteinuric CKD patients.

Methods

This is a retrospective observational study of insurance claim database from 1/1/07 to 12/31/17 examining the effect of ACEI or ARB use on CKD progression. Inclusion criteria: adults at least 18 years of age, with CKD stage 3 or higher [based on at least 2 serum creatinine (SCr) values 90 days apart] with at least 2 urinalyses with dipstick urine protein with negative or trace, follow-up (FU) period of at least 3 yrs. Patients with diabetes or proteinuria were excluded. Primary outcomes were doubling of SCr, or reaching CKD stage 5. Mortality data was not available. Duration of ACEI/ARB exposure is defined as number of prescribed days. The eGFR was calculated based on CKD-EPI equation. Analysis are performed with 2 models: time varying Cox regression, and mixed model (which included time-period fixed effect and random effects). A greedy 1:1 propensity score matching scheme was applied.

Results

Of 20,000 CKD patients, there were 2,853 with CKD stage 3 or higher without proteinuria, with 301 on ACEI/ARB during mean FU 6 yrs. Percentage of patients with HTN or CHF, mean age, gender, and eGFR did not differ between ACEI/ARB vs. non-ACEI/ARB groups. The eGFR decrease per year was not statistically different between those on ACEI/ARB vs. non-ACEI/ARB group (matched cox model, p = 0.2285; mixed model, p = 0.4346 respectively). Age and ACEI/ARB duration of exposure have no effect. ACEI/ARB patients had lower rate of developing diabetes during the study (OR 0.57, p = 0.0044), and higher rate of proteinuria at the end of study (OR 1.59, p = 0.0048), though these associations were not observed in the matched sample.

Conclusion

This study suggests ACEI/ARB does not affect CKD progression in non-diabetic & non-proteinuric patients, irrespective of age. Further studies are needed to confirm those findings.