Chronic Kidney Disease and Cardiovascular Risk

Chronic kidney disease (CKD) independently increases the risk of death and cardiovascular disease (CVD) in the general population. Participants with an estimated glomerular filtration rate (eGFR) decline have a significantly higher risk of all‐cause mortality and cardiovascular events even after adjustment for baseline covariates including the initial eGFR.

The certainty of using drugs that block the renin-angiotensin system in such patients whose estimated GFR is low has been a question. To uncover this, researchers from Pennsylvania conducted a retrospective cohort study that was published in JAMA Internal Medicine.

Continuing angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) in patients with declining kidney function may deliver cardiovascular benefits without increasing the risk of end-stage kidney disease (ESKD), according to the study.

Study Details

The retrospective cohort study included 3909 individuals who had initiated ACE-I or ARB therapy and had experienced an estimated glomerular filtration rate (eGFR) decrease to <30 mL/min/1.73m² during therapy. The study started on 1 January 2004 and continued until 25 January 2019. Findings of the study were:

• Of the 3909 individuals receiving ACE-I or ARB treatment who experienced an eGFR decrease to below 30 mL/min/1.73 m², mean age was 73.7 years; 1235 discontinued ACE-I or ARB therapy within 6 months after the eGFR decrease and 2674 did not discontinue therapy.
• A total of 434 patients who discontinued ACE-I or ARB therapy and 786 who did not discontinue therapy died during a median follow-up of 2.9 years.
• Among the sample, patients who discontinued ACE-I or ARB therapy were associated with a higher risk of mortality (hazard ratio [HR], 1.39) and major adverse cardiovascular events (MACE) (HR, 1.37), but no statistically significant difference in the risk of ESKD was found.

The authors concluded that the findings suggest continuing ACE-I or ARB therapy in patients with declining kidney function may be associated with cardiovascular benefits without excessive harm of ESKD.

For further reading, click on the following link: doi:10.1001/jamainternmed.2020.0193