Kidney Week

Abstract: FR-OR43

Association of Leukotriene Antagonist Use with the Incidence of ESKD

Session Information

• Interventions to Reduce CKD Progression
  November 03, 2023 | Location: Room 119, Pennsylvania Convention Center
  Abstract Time: 04:48 PM - 04:57 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kendrick, Jessica B., University of Colorado, Denver, Colorado, United States

Jessica B. Kendrick, MD, MPH

• Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Prabin Shrestha,

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida,

• Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Lu, Jun Ling, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Jun Ling Lu,

• Furgeson, Seth B., University of Colorado, Denver, Colorado, United States

Seth B. Furgeson,

• Kalantar-Zadeh, Kamyar, University of California Los Angeles, Los Angeles, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Pro-inflammatory lipid mediators known as leukotrienes (LTR) have been implicated in the etiology of chronic kidney disease (CKD). We have found that short-term inhibition of cysteinyl LTRs in mice with montelukast inhibits CKD progression after acute kidney injury. Whether LTR inhibitor use is associated with a reduction in kidney disease in humans is not known. We examined the association of LTR inhibitor (LTRi) therapies with the risk of developing end stage kidney disease (ESKD).

Methods

In a national cohort of 651,509 US Veterans with a diagnosis of asthma or allergic rhinitis, we identified 50,895 incident users of LTRi (montelukast or zafirlukast) and 600,614 patients who did not receive LTRi. We examined the association of LTRi with ESKD in competing risk regressions and cause-specific Cox models. We used propensity score (PS) weighing to account for differences in demographics, comorbidities, relevant medication use and laboratory values between the two groups. ESKD was determined using USRDS data.

Results

The overall mean (SD) age was 61±13 years, 91% were male and 79% were white. The mean (SD) baseline eGFR and BMI were 73±21 ml/min/1.73m² and 29±6.4 kg/m², respectively. UACR of 30-300 and >300 mg/gm was present in 10% and 3.6% of patients at baseline, respectively. There were 4,055 cases of incident ESKD over a median follow-up of 9.8 years, with 160 events in LTRi treated patients (event rate and 95%CI: 5.0/1000PY, 4.2-5.7) and 3,895 events in untreated patients (7.1/1000PY, 6.9-7.4). LTRi use was associated with a significantly lower risk of incident ESKD in both PS-weighed competing risk regression and in a PS-weighed cause-specific Cox model (Table).

Conclusion

In this large cohort of patients with a diagnosis of asthma and allergic rhinitis, use of LTRi was associated with a lower risk of incident ESKD.

Funding

• Veterans Affairs Support