Effect of Renin−Angiotensin−Aldosterone System Blockade on Outcomes in Patients With ESRD

A Prospective Cohort Study in Korea

Clinical Research Center of End Stage Renal Disease Investigators

Research output: Contribution to journalArticle

Abstract

Introduction: Conflicting results still exist regarding the benefit of renin−angiotensin−aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD). Methods: Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regression was applied for risk factor analysis with the cumulative duration of RAAS blockade use as time-varying covariate. The risks for mortality from all causes and major cardiovascular event−free survival were estimated. Results: Compared to the control group, patients in the RAAS group were younger but had a higher proportion of diabetes mellitus, had higher systolic blood pressure, required a greater number of prescribed antihypertensive drugs, and had a longer dialysis duration. On multivariate time-varying Cox regression analysis, the RAAS group with cumulative duration of >90 days was significantly associated with a lower risk of mortality from all causes after adjustment for confounding (hazard ratio [HR] = 0.45, 95% confidence interval [CI] = 0.35–0.58, P < 0.0001). Major cardiovascular event−free survival was also better for the RAAS group than for the control group on multivariate analysis (HR = 0.27, 95% CI = 0.20–0.37, P < 0.0001), considering the cumulative duration of RAAS blockade use. Conclusion: In Korean patients with ESRD, we reported a specific benefit of RAAS blockade in improving overall survival after adjustment for confounding factors from real-world data.

Original languageEnglish
Pages (from-to)1385-1393
Number of pages9
JournalKidney International Reports
Volume3
Issue number6
DOIs
Publication statusPublished - 2018 Nov 1

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Korea
Chronic Kidney Failure
Cohort Studies
Prospective Studies
Survival
Dialysis
Confidence Intervals
Control Groups
Mortality
Antihypertensive Agents
Statistical Factor Analysis
Diabetes Mellitus
Multivariate Analysis
Regression Analysis
Blood Pressure
Hypertension
Research

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Clinical Research Center of End Stage Renal Disease Investigators. / Effect of Renin−Angiotensin−Aldosterone System Blockade on Outcomes in Patients With ESRD : A Prospective Cohort Study in Korea. In: Kidney International Reports. 2018 ; Vol. 3, No. 6. pp. 1385-1393.
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title = "Effect of Renin−Angiotensin−Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea",
abstract = "Introduction: Conflicting results still exist regarding the benefit of renin−angiotensin−aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD). Methods: Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regression was applied for risk factor analysis with the cumulative duration of RAAS blockade use as time-varying covariate. The risks for mortality from all causes and major cardiovascular event−free survival were estimated. Results: Compared to the control group, patients in the RAAS group were younger but had a higher proportion of diabetes mellitus, had higher systolic blood pressure, required a greater number of prescribed antihypertensive drugs, and had a longer dialysis duration. On multivariate time-varying Cox regression analysis, the RAAS group with cumulative duration of >90 days was significantly associated with a lower risk of mortality from all causes after adjustment for confounding (hazard ratio [HR] = 0.45, 95{\%} confidence interval [CI] = 0.35–0.58, P < 0.0001). Major cardiovascular event−free survival was also better for the RAAS group than for the control group on multivariate analysis (HR = 0.27, 95{\%} CI = 0.20–0.37, P < 0.0001), considering the cumulative duration of RAAS blockade use. Conclusion: In Korean patients with ESRD, we reported a specific benefit of RAAS blockade in improving overall survival after adjustment for confounding factors from real-world data.",
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Effect of Renin−Angiotensin−Aldosterone System Blockade on Outcomes in Patients With ESRD : A Prospective Cohort Study in Korea. / Clinical Research Center of End Stage Renal Disease Investigators.

In: Kidney International Reports, Vol. 3, No. 6, 01.11.2018, p. 1385-1393.

Research output: Contribution to journalArticle

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T1 - Effect of Renin−Angiotensin−Aldosterone System Blockade on Outcomes in Patients With ESRD

T2 - A Prospective Cohort Study in Korea

AU - Clinical Research Center of End Stage Renal Disease Investigators

AU - Yoo, Kyung Don

AU - Kim, Clara Tammy

AU - Kim, Yunmi

AU - Kim, Hyo Jin

AU - Park, Jae Yoon

AU - Park, Ji In

AU - Oh, Yun Kyu

AU - Kang, Shin-Wook

AU - Yang, Chul Woo

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Lim, Chun Soo

AU - Lee, Jung Pyo

PY - 2018/11/1

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N2 - Introduction: Conflicting results still exist regarding the benefit of renin−angiotensin−aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD). Methods: Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regression was applied for risk factor analysis with the cumulative duration of RAAS blockade use as time-varying covariate. The risks for mortality from all causes and major cardiovascular event−free survival were estimated. Results: Compared to the control group, patients in the RAAS group were younger but had a higher proportion of diabetes mellitus, had higher systolic blood pressure, required a greater number of prescribed antihypertensive drugs, and had a longer dialysis duration. On multivariate time-varying Cox regression analysis, the RAAS group with cumulative duration of >90 days was significantly associated with a lower risk of mortality from all causes after adjustment for confounding (hazard ratio [HR] = 0.45, 95% confidence interval [CI] = 0.35–0.58, P < 0.0001). Major cardiovascular event−free survival was also better for the RAAS group than for the control group on multivariate analysis (HR = 0.27, 95% CI = 0.20–0.37, P < 0.0001), considering the cumulative duration of RAAS blockade use. Conclusion: In Korean patients with ESRD, we reported a specific benefit of RAAS blockade in improving overall survival after adjustment for confounding factors from real-world data.

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