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Abstract: SA-PO905

Outcomes Differences in User vs. Non-User of Renin-Angiotensin Blockers in Early CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Prasad, Narayan, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Kundu, Monica, The George Institute for Global Health India, New Delhi, Delhi, India
  • Yadav, Ashok Kumar, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Kumar, Vivek, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Jha, Vivekanand, The George Institute for Global Health India, New Delhi, Delhi, India

Group or Team Name

  • Indian Chronic Kidney Disease Study Group
Background

Renin-angiotensin-aldosterone-system blockers (RASB) are the antihypertensive drug class of choice in patients with CKD. There are few head-to-head comparisons of the renal or nonrenal outcomes between RASB users and non-users. We aimed to compare the renal and cardiovascular outcomes between the two in patients enrolled in the Indian Chronic Kidney Disease (ICKD) Study.

Methods

A total of 4050 patients with mild-moderate CKD recruited in the ICKD cohort were studied. Patients were categorized as ARB users or nonusers. The renal outcomes [50% decline in eGFR and end stage kidney disease (ESKD)], all-cause mortality, and cardiovascular mortality was analysed over a median follow up period of 2.65 (1.40, 3.89) years between RASB users and nonusers.

Results

Out of a total of 4056 patients, 3487 (86%) were hypertensive. A total of 82 (89%) out of 92 in stage 1, 192 (70%) out of 275 in stage 2, 1677 (61%) out of 2742 in stage 3 and 154 (41%) out of 378 in stage 4 hypertensive patients received RASBs. The rate of decline of eGFR in RASB user was numerically low as compared to non-users (Figure 1). The adjusted hazard ratio (HR) for RASB user for a 50% decline in eGFR, ESKD, all-cause mortality and cardiovascular mortality was 0.72, 0.72, 0.59, and 0.48 respectively (Figure 2).

Conclusion

The use of RASBs decreased with advancing CKD stages from stage 1 to 4. RASB use is associated with slower rate of decline in eGFR in those with CKD stage 1-3. RASB users had a significantly lower risk of all-cause mortality and cardiovascular mortality

Funding

  • Government Support – Non-U.S.