Introduction:
Randomized controlled trials have shown beneficial effect of Angiotensin converting enzyme inhibitors (ACEI) in reducing mortality in patients with systolic heart failure (HF) and chronic kidney disease (CKD) with glomerular filtration rate (GFR) between 30-59 ml/min/1.73m2 but weak evidence exists in patients with GFR < 30
Hypothesis:
We hypothesize that ACEI use is associated with lower mortality in CKD patients with GFR < 30.
Methods:
Using electronic medical records, we identified 2578 patients with advanced CKD defined as GFR < 30 but not on dialysis. We required a GFR < 30 on two occasions over a 60 day period to insure stability of CKD. Clinical outcomes were reviewed following the index date which was the date of first GFR < 30.
Results:
Of 2,578 patients (mean age 66+/-15, 61% males) with advanced CKD (GFR<30), 1,064 (41%) have been treated with an ACEI while 1,514 (59%) never received an ACEI. Kaplan Meyer Survival showed reduced mortality in the group of patients treated with an ACEI compared to those never treated with an ACEI despite more comorbidities present in the former group (mean survival 3.9 vs 4.8 years, p<0.001, Fig 1). Of the patients treated with an ACEI, 232 (22%) continued the ACEI till the end of follow up while 832 (78%) patients discontinued the drug: 93 (9%) prior to index date and 739 (69%) after index date. Survival was significantly better in patients who continued the ACEI than those who discontinued the drug late (after the index date) and those who discontinued early (prior to index date) than in those never treated with an ACEI (Fig 2).
Conclusion:
Treatment with ACEIs is associated with improved survival in CKD patients with GFR < 30ml/min/1.73m2
Angiotensin-converting enzyme inhibitors, beta-blockers, and mortality in systolic heart failure