Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure

Se Yong Jang, Shung Chull Chae, Myung Hwan Bae, Jang Hoon Lee, Dong Heon Yang, Hun Sik Park, Yongkeun Cho, Hyun Jai Cho, Hae Young Lee, Byung Hee Oh, Jin Oh Choi, Eun Seok Jeon, Min Seok Kim, Sang Eun Lee, Jae Joong Kim, Kyung Kuk Hwang, Myeong Chan Cho, Sang Hong Baek, seokmin kang, Dong Ju Choi & 4 others Byung Su Yoo, Youngkeun Ahn, Kye Hun Kim, Hyun Young Park

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Abstract

Background: Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure. Methods and Results: Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40% and estimated glomerular filtration rate < 30 mL/min/1.73 m2 during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6%) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7% and 53.8% for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269–0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731–1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005). Conclusions: Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.

Original languageEnglish
Pages (from-to)180-186
Number of pages7
JournalInternational Journal of Cardiology
Volume266
DOIs
Publication statusPublished - 2018 Sep 1

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Renin-Angiotensin System
Renal Insufficiency
Heart Failure
Renal Replacement Therapy
Survival Analysis
Kidney
Kaplan-Meier Estimate
Glomerular Filtration Rate
Acute Kidney Injury
Stroke Volume
Survivors
Registries
Hospitalization
Therapeutics
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Jang, Se Yong ; Chae, Shung Chull ; Bae, Myung Hwan ; Lee, Jang Hoon ; Yang, Dong Heon ; Park, Hun Sik ; Cho, Yongkeun ; Cho, Hyun Jai ; Lee, Hae Young ; Oh, Byung Hee ; Choi, Jin Oh ; Jeon, Eun Seok ; Kim, Min Seok ; Lee, Sang Eun ; Kim, Jae Joong ; Hwang, Kyung Kuk ; Cho, Myeong Chan ; Baek, Sang Hong ; kang, seokmin ; Choi, Dong Ju ; Yoo, Byung Su ; Ahn, Youngkeun ; Kim, Kye Hun ; Park, Hyun Young. / Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure. In: International Journal of Cardiology. 2018 ; Vol. 266. pp. 180-186.
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title = "Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure",
abstract = "Background: Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure. Methods and Results: Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40{\%} and estimated glomerular filtration rate < 30 mL/min/1.73 m2 during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6{\%}) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7{\%} and 53.8{\%} for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269–0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731–1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005). Conclusions: Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.",
author = "Jang, {Se Yong} and Chae, {Shung Chull} and Bae, {Myung Hwan} and Lee, {Jang Hoon} and Yang, {Dong Heon} and Park, {Hun Sik} and Yongkeun Cho and Cho, {Hyun Jai} and Lee, {Hae Young} and Oh, {Byung Hee} and Choi, {Jin Oh} and Jeon, {Eun Seok} and Kim, {Min Seok} and Lee, {Sang Eun} and Kim, {Jae Joong} and Hwang, {Kyung Kuk} and Cho, {Myeong Chan} and Baek, {Sang Hong} and seokmin kang and Choi, {Dong Ju} and Yoo, {Byung Su} and Youngkeun Ahn and Kim, {Kye Hun} and Park, {Hyun Young}",
year = "2018",
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Jang, SY, Chae, SC, Bae, MH, Lee, JH, Yang, DH, Park, HS, Cho, Y, Cho, HJ, Lee, HY, Oh, BH, Choi, JO, Jeon, ES, Kim, MS, Lee, SE, Kim, JJ, Hwang, KK, Cho, MC, Baek, SH, kang, S, Choi, DJ, Yoo, BS, Ahn, Y, Kim, KH & Park, HY 2018, 'Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure', International Journal of Cardiology, vol. 266, pp. 180-186. https://doi.org/10.1016/j.ijcard.2018.03.016

Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure. / Jang, Se Yong; Chae, Shung Chull; Bae, Myung Hwan; Lee, Jang Hoon; Yang, Dong Heon; Park, Hun Sik; Cho, Yongkeun; Cho, Hyun Jai; Lee, Hae Young; Oh, Byung Hee; Choi, Jin Oh; Jeon, Eun Seok; Kim, Min Seok; Lee, Sang Eun; Kim, Jae Joong; Hwang, Kyung Kuk; Cho, Myeong Chan; Baek, Sang Hong; kang, seokmin; Choi, Dong Ju; Yoo, Byung Su; Ahn, Youngkeun; Kim, Kye Hun; Park, Hyun Young.

In: International Journal of Cardiology, Vol. 266, 01.09.2018, p. 180-186.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure

AU - Jang, Se Yong

AU - Chae, Shung Chull

AU - Bae, Myung Hwan

AU - Lee, Jang Hoon

AU - Yang, Dong Heon

AU - Park, Hun Sik

AU - Cho, Yongkeun

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Oh, Byung Hee

AU - Choi, Jin Oh

AU - Jeon, Eun Seok

AU - Kim, Min Seok

AU - Lee, Sang Eun

AU - Kim, Jae Joong

AU - Hwang, Kyung Kuk

AU - Cho, Myeong Chan

AU - Baek, Sang Hong

AU - kang, seokmin

AU - Choi, Dong Ju

AU - Yoo, Byung Su

AU - Ahn, Youngkeun

AU - Kim, Kye Hun

AU - Park, Hyun Young

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure. Methods and Results: Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40% and estimated glomerular filtration rate < 30 mL/min/1.73 m2 during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6%) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7% and 53.8% for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269–0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731–1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005). Conclusions: Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.

AB - Background: Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure. Methods and Results: Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40% and estimated glomerular filtration rate < 30 mL/min/1.73 m2 during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6%) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7% and 53.8% for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269–0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731–1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005). Conclusions: Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.

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U2 - 10.1016/j.ijcard.2018.03.016

DO - 10.1016/j.ijcard.2018.03.016

M3 - Article

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SP - 180

EP - 186

JO - International Journal of Cardiology

JF - International Journal of Cardiology

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