Yi-Chun Chen, Chien-Hsueh Tung, Ben-Hui Yu
Journal of the Endocrine Society, Volume 8, Issue 8, August 2024, bvae119
https://doi.org/10.1210/jendso/bvae119
Limited evidence exists regarding the cumulative dosing and duration impact of renin-angiotensin system inhibitors (RASis) on cardiorenal and mortality outcomes in patients with advanced stages (predominantly in stage 5 and a minority in stage 4) of diabetic kidney disease (DKD).
To retrospectively investigate whether there are dose- and time-dependent relationships between RASis and cardiorenal and mortality outcomes in this population.
Using Taiwan’s national health insurance data in 2000–2017, we analyzed 2196 RASi users and 2196 propensity-matched nonusers among 8738 patients living with diabetes and newly diagnosed with advanced chronic kidney disease (23% stage 4, 77% stage 5). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% CI.
RASi use was significantly associated with reduced risks of all-cause mortality (aHR, 0.53; 95% CI 0.47–0.60) and cardiovascular mortality (0.68; 0.56–0.83) with the degree of benefit depending on therapeutic dosage and duration, despite a nonsignificant increase in acute kidney injury risk (1.16; 0.98–1.38) and a significant increase in hyperkalemia risk (1.45; 1.19–1.77). Significant differences in proteinuria risk (1.32; 1.21–1.43) were observed, while there were no significant differences in end-stage renal disease risk (1.01; 0.88–1.15) and no dose– or time–response relationships for either end-stage renal disease or proteinuria risks. Sensitivity analyses confirmed cardiovascular and survival benefits, even in patients with stage 5 DKD.
This real-world study suggests that RASi use in advanced stages 4 to 5 DKD may provide dose- and time-dependent cardioprotection and improved survival, without excess renal harms.
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