Clinical Outcomes of Renin-Angiotensin-Aldosterone Blockade in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-analysis.
Can J Cardiol
; 40(9): 1718-1728, 2024 Sep.
Article
en En
| MEDLINE
| ID: mdl-38458564
ABSTRACT
BACKGROUND:
The cardiovascular and renal benefits of renin-angiotensin aldosterone system (RAAS) blockade are not well established in patients with advanced chronic kidney disease (CKD). We conducted a systematic review and meta-analysis to identify potential risks and benefits from RAAS blockade in patients with CKD stage 4-5.METHODS:
A Medline search from inception to November 2022 was conducted to identify randomised controlled trials (RCTs) in patients with CKD stage 4-5 (estimated glomerular filtration rate ≤ 30 mL/min/1.73 m2) comparing RAAS blockade vs placebo or alternative antihypertensive therapy. Different intervention strategies were assessed (RAAS use vs nonuse, initiation vs placebo/alternative therapy, or discontinuation vs continuation). The primary outcome was progression to end-stage kidney disease (ESKD). Secondary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). The risk ratio (RR) was estimated with the use of a random-effects model.RESULTS:
Nine RCTs (1150 patients) were included. RAAS blockade was associated with a significant reduction in progression to ESKD RR 0.84 (95% confidence interval [CI] 0.74-0.96; P = 0.01). There was no benefit from RAAS blockade on all-cause mortality or MACE RR 1.02 (95% CI 0.63-1.65; P = 0.93) and RR 0.87 (95% CI 0.49-1.57; P = 0.65), respectively.CONCLUSIONS:
RAAS blockade may be considered in selected patients with CKD stage 4-5 to delay progression to ESKD.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Sistema Renina-Angiotensina
/
Inhibidores de la Enzima Convertidora de Angiotensina
/
Insuficiencia Renal Crónica
/
Fallo Renal Crónico
Límite:
Humans
Idioma:
En
Revista:
Can J Cardiol
Asunto de la revista:
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Reino Unido