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; Seok Min Kang; Dong Ju Choi; Byung Su Yoo; Youngkeun Ahn; Kye Hun Kim; Hyun Young Park

doi:10.1016/j.ijcard.2018.03.016

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, Seok Min Kang, Dong Ju ChoiByung 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 language	English
Pages (from-to)	180-186
Number of pages	7
Journal	International Journal of Cardiology
Volume	266
DOIs	https://doi.org/10.1016/j.ijcard.2018.03.016
Publication status	Published - 2018 Sept 1

Bibliographical note

Funding Information:
The KorAHF registry was supported by the Research of Korea Centers for Disease Control and Prevention [ 2010-E63003-00 , 2011-E63002-00 , 2012-E63005-00 , 2013-E63003-00 , 2013-E63003-01 , 2013-E63003-02 , 2016-ER6303-00 ].

Publisher Copyright:
© 2018 Elsevier B.V.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1016/j.ijcard.2018.03.016

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Jang, S. Y., Chae, S. C., Bae, M. H., Lee, J. H., Yang, D. H., Park, H. S., Cho, Y., Cho, H. J., Lee, H. Y., Oh, B. H., Choi, J. O., Jeon, E. S., Kim, M. S., Lee, S. E., Kim, J. J., Hwang, K. K., Cho, M. C., Baek, S. H., Kang, S. M., ... Park, H. Y. (2018). Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure. International Journal of Cardiology, 266, 180-186. https://doi.org/10.1016/j.ijcard.2018.03.016

@article{983dc28ab09b47d5904de58165db04f2,

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 Kang, {Seok Min} and Choi, {Dong Ju} and Yoo, {Byung Su} and Youngkeun Ahn and Kim, {Kye Hun} and Park, {Hyun Young}",

note = "Funding Information: The KorAHF registry was supported by the Research of Korea Centers for Disease Control and Prevention [ 2010-E63003-00 , 2011-E63002-00 , 2012-E63005-00 , 2013-E63003-00 , 2013-E63003-01 , 2013-E63003-02 , 2016-ER6303-00 ]. Publisher Copyright: {\textcopyright} 2018 Elsevier B.V.",

year = "2018",

month = sep,

day = "1",

doi = "10.1016/j.ijcard.2018.03.016",

language = "English",

volume = "266",

pages = "180--186",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

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, SM, 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

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, Seok Min

AU - Choi, Dong Ju

AU - Yoo, Byung Su

AU - Ahn, Youngkeun

AU - Kim, Kye Hun

AU - Park, Hyun Young

N1 - Funding Information: The KorAHF registry was supported by the Research of Korea Centers for Disease Control and Prevention [ 2010-E63003-00 , 2011-E63002-00 , 2012-E63005-00 , 2013-E63003-00 , 2013-E63003-01 , 2013-E63003-02 , 2016-ER6303-00 ]. Publisher Copyright: © 2018 Elsevier B.V.

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.

UR - http://www.scopus.com/inward/record.url?scp=85048067247&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048067247&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2018.03.016

DO - 10.1016/j.ijcard.2018.03.016

M3 - Article

C2 - 29887444

AN - SCOPUS:85048067247

SN - 0167-5273

VL - 266

SP - 180

EP - 186

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

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

Abstract

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