TY - JOUR
T1 - Association of renin-angiotensin system inhibitors with long-term outcomes in patients with systolic heart failure and moderate-to-severe kidney function impairment
AU - West Tokyo Heart Failure (WET-HF) Registry Investigators
AU - Higuchi, Satoshi
AU - Kohsaka, Shun
AU - Shiraishi, Yasuyuki
AU - Katsuki, Toshiomi
AU - Nagatomo, Yuji
AU - Mizuno, Atsushi
AU - Sujino, Yasumori
AU - Kohno, Takashi
AU - Goda, Ayumi
AU - Yoshikawa, Tsutomu
N1 - Funding Information:
Dr. Kohsaka received an unrestricted research grant for the Department of Cardiology, Keio University School of Medicine from Bayer Pharmaceutical Co., Ltd. and Daiichi Sankyo Co. Ltd. and personal fees from Bristol-Myers Squibb / Pfizer. Other authors have no conflicts of interest to disclose.
Funding Information:
This work was supported by a Grant-in-Aid for Young Scientists ( JSPS KAKENHI , 17K18085 [S.H], 18K15860 [Y.S]), a Grant-in-Aid for Scientific Research ( 23591062 , 26461088 [T.Y], 16H05215 , 16KK0186 [S.K], 17K09526 [T.K]), Health Labour Sciences Research Grant ( 14528506 [T.Y.]), the Sakakibara Clinical Research Grant for Promotion of Sciences (2012, 2013, 2014 [T.Y.]), and a Grant from the Japan Agency for Medical Research and Development ( 201439013C [S.K.]).
Publisher Copyright:
© 2019 European Federation of Internal Medicine
PY - 2019/4
Y1 - 2019/4
N2 - Purpose: Although guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) should be treated with renin-angiotensin system (RAS) inhibitors, the long-term efficacy of RAS inhibitors in HFrEF patients with moderate-to-severe chronic kidney disease (CKD) remains unclear. Methods: The present study included consecutive patients hospitalized for acute heart failure across five Japanese teaching hospitals. The impact of RAS inhibitors on 2-year all-cause mortality was evaluated in patients with an ejection fraction ≤40% and CKD, defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m 2 , at discharge. Its severity was subclassified from 3B to 5 according to eGFR. Results: Overall, 553 patients (age, 76 ± 11 years; 68% male) were included. RAS inhibitors were prescribed more frequently in 227 patients with stage 3B (71.2%) than in 107 patients with stage 4 or 5 CKD (45.7%). All-cause mortality was recorded in 119 patients (23.4%) (55 [18.5%] patients with stage 3B; 64 [30.3%] patients with stage 4 or 5 CKD), within the median follow-up period of 609 (220–983) days. After many-to-one propensity score matching (87 pairs in stage 3; 60 pairs in stage 4 or 5 CKD), those with RAS inhibitors had reduced mortality rate in stage 3B (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.19–0.83) but not in stage 4 or 5 CKD (HR, 1.08; 95% CI, 0.57–2.03). Conclusions: In HFrEF patients with CKD, RAS inhibitors are associated with reduction in mortality in stage 3B CKD, but the association is less clear in stage 4 or 5 CKD.
AB - Purpose: Although guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) should be treated with renin-angiotensin system (RAS) inhibitors, the long-term efficacy of RAS inhibitors in HFrEF patients with moderate-to-severe chronic kidney disease (CKD) remains unclear. Methods: The present study included consecutive patients hospitalized for acute heart failure across five Japanese teaching hospitals. The impact of RAS inhibitors on 2-year all-cause mortality was evaluated in patients with an ejection fraction ≤40% and CKD, defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m 2 , at discharge. Its severity was subclassified from 3B to 5 according to eGFR. Results: Overall, 553 patients (age, 76 ± 11 years; 68% male) were included. RAS inhibitors were prescribed more frequently in 227 patients with stage 3B (71.2%) than in 107 patients with stage 4 or 5 CKD (45.7%). All-cause mortality was recorded in 119 patients (23.4%) (55 [18.5%] patients with stage 3B; 64 [30.3%] patients with stage 4 or 5 CKD), within the median follow-up period of 609 (220–983) days. After many-to-one propensity score matching (87 pairs in stage 3; 60 pairs in stage 4 or 5 CKD), those with RAS inhibitors had reduced mortality rate in stage 3B (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.19–0.83) but not in stage 4 or 5 CKD (HR, 1.08; 95% CI, 0.57–2.03). Conclusions: In HFrEF patients with CKD, RAS inhibitors are associated with reduction in mortality in stage 3B CKD, but the association is less clear in stage 4 or 5 CKD.
KW - CKD
KW - Chronic kidney disease
KW - HFrEF
KW - Heart failure with reduced ejection fraction
KW - Renin-angiotensin system inhibitor
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U2 - 10.1016/j.ejim.2019.01.014
DO - 10.1016/j.ejim.2019.01.014
M3 - Article
C2 - 30737061
AN - SCOPUS:85061007434
VL - 62
SP - 58
EP - 66
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
SN - 0953-6205
ER -