Abstract: SA-PO902
Incident Thiazide Use and Renal and Non-Renal Outcomes in Mild-to-Moderate CKD: A Large Nationwide Observational Study of US Veterans
Session Information
- CKD: Clinical Trials and Pharmacoepidemiology
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials
Authors
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Mallisetty, Yamini, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Naser, Abu Mohd, The University of Memphis, Memphis, Tennessee, United States
- Surbhi, Satya, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Streja, Elani, University of California Irvine, Irvine, California, United States
- Rhee, Connie, University of California Irvine, Irvine, California, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Thiazide diuretics are widely used for the treatment of hypertension and to improve outcomes in hypertensive patients without kidney disease. It is unclear whether the use of thiazides improves outcomes in patients with mild-to-moderate CKD.
Methods
In a nationwide cohort of >3.5 million US veterans, we identified 2,494 patients with an eGFR ≥45 mL/min/1.73m2 who were incident new users of thiazides. Within the same 180-day calendar period, we identified 104,277 comparators who never used thiazides during the entire follow-up. After 1:1 propensity-score (PS) matching for socio-demographics, comorbidities, vital signs, eGFR, UACR, serum sodium and calcium, and relevant medications, the associations of thiazide use with incident ESKD and all-cause mortality were examined using competing risk regression and Cox regression models, respectively, overall and by subgroups of loop diuretic use status.
Results
Baseline characteristics were similar in patients with and without thiazide use (n=1,593 each) after PS matching. There were 53 and 823 cases of incident ESKD and all-cause death (event rates [95%CI], 3.1 [2.4-4.1] and 41.2 [38.5-44.2]/1000 PY) over a median follow-up of 5.4 and 6.1 years, respectively. Thiazide use was significantly associated with lower risk of all-cause mortality (HR [95%CI], 0.83 [0.73-0.93]) but not with incident ESKD (sub-HR [95%CI], 1.40 [0.81-2.40]). There was a significant interaction between loop and thiazide diuretic use, with the significantly lower thiazide-associated mortality risk only seen in patients without loop diuretic use (Table).
Conclusion
In patients with CKD stages G1-G3a, thiazide use was associated with significantly lower all-cause mortality but not with higher or lower incident ESKD. The lack of significant thiazide-mortality association among loop diuretic users may suggest the need for prudent use of combination diuretic therapy in patients with mild-to-moderate CKD.
Associations of incident thiazide use (vs. no use) with outcomes in PS-matched cohort
| Incident ESKD | All-cause mortality | |||||||||
| SHR | 95% CI | P | P for interaction | HR | 95% CI | P | P for interaction | |||
| Overall | 1.40 | 0.81 | 2.40 | 0.23 | N/A | 0.83 | 0.73 | 0.96 | 0.009 | N/A |
| Subgroup | ||||||||||
| No loop diuretic use | 1.49 | 0.84 | 2.69 | 0.17 | 0.55 | 0.80 | 0.69 | 0.93 | 0.004 | 0.035 |
| Loop diuretic use | 0.93 | 0.21 | 4.13 | 0.92 | 1.22 | 0.85 | 1.76 | 0.27 | ||
Funding
- Veterans Affairs Support