Effects of renin-angiotensin system inhibitors on the incidence of unplanned dialysis

Takashin Nakayama, Kohkichi Morimoto, Kiyotaka Uchiyama, Ei Kusahana, Naoki Washida, Tatsuhiko Azegami, Takeshi Kanda, Tadashi Yoshida, Hiroshi Itoh

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Unplanned dialysis initiation is associated with poor outcomes. It is controversial whether patients with advanced chronic kidney disease (CKD) should receive renin-angiotensin system (RAS) inhibitor therapy. The aim of this study was to evaluate the effect of RAS inhibitor therapy in patients with advanced CKD on the incidence of unplanned dialysis initiation. This single-center, retrospective study included patients who started maintenance dialysis at our hospital between April 2014 and March 2021. Patients who initiated dialysis within 6 months of nephrology referral or after kidney transplant were excluded. Among 334 patients (aged 70.0 [59.0–79.0] years; 28.4% women), 186 (55.7%) and 148 (44.3%) had planned and unplanned dialysis initiation, respectively. Multivariate logistic regression analysis revealed that the use of RAS inhibitors was significantly associated with a lower incidence of unplanned dialysis initiation (odds ratio [OR], 0.36; P < 0.01). Female sex (OR, 0.41; P < 0.05), use of potassium binders (OR, 0.28; P < 0.001), earlier referral to nephrology (OR, 0.39; P < 0.01), and earlier discussion of renal replacement therapy (OR, 0.33; P < 0.001) were also significantly associated with a lower incidence, whereas older age (OR, 1.28; P < 0.05), higher Charlson Comorbidity Index (OR, 1.24; P < 0.05), and faster decline in kidney function (OR, 1.29; P < 0.01) were associated with a higher risk of unplanned dialysis initiation. RAS inhibitor therapy in patients with advanced CKD is associated with a lower risk of unplanned dialysis initiation.

Original languageEnglish
Pages (from-to)1018-1027
Number of pages10
JournalHypertension Research
Volume45
Issue number6
DOIs
Publication statusPublished - 2022 Jun

Keywords

  • Advanced chronic kidney disease
  • Renal replacement therapy
  • Renin-angiotensin system inhibitor
  • Unplanned dialysis initiation

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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