心衰患者使用血管紧张素受体阻滞剂与ACE抑制剂的肾衰竭风险更高

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine Pub Date : 2025-05-24 DOI:10.1016/j.amjmed.2025.05.024

Hans J Moore, Wen-Chih Wu, Paul A Heidenreich, Patrick Rossignol, Samir S Patel, Frederick Lu, Phillip H Lam, Amiya A Ahmed, Charles Faselis, Javed Butler, Carlos E Palant, Bertram Pitt, Matthew R Weir, Prakash Deedwania, David Atkins, Venkatesh K Raman, Janani Rangaswami, Jose D Vargas, Sijian Zhang, Charity J Morgan, Helen M Sheriff, Qing Zeng-Treitler, Gregg C Fonarow, Ali Ahmed

{"title":"心衰患者使用血管紧张素受体阻滞剂与ACE抑制剂的肾衰竭风险更高","authors":"Hans J Moore, Wen-Chih Wu, Paul A Heidenreich, Patrick Rossignol, Samir S Patel, Frederick Lu, Phillip H Lam, Amiya A Ahmed, Charles Faselis, Javed Butler, Carlos E Palant, Bertram Pitt, Matthew R Weir, Prakash Deedwania, David Atkins, Venkatesh K Raman, Janani Rangaswami, Jose D Vargas, Sijian Zhang, Charity J Morgan, Helen M Sheriff, Qing Zeng-Treitler, Gregg C Fonarow, Ali Ahmed","doi":"10.1016/j.amjmed.2025.05.024","DOIUrl":null,"url":null,"abstract":"Background: Renin-angiotensin system (RAS) inhibition with angiotensin-covering enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is associated with a lower risk of kidney failure in patients with heart failure. We examined whether this association varies between ACEIs and ARBs.Methods: From 300,361 Veterans with heart failure without kidney failure initiated on ACEIs (n=256,224) or ARBs (n=44,137), we assembled a propensity score-matched cohort of 88,178 patients while remaining blinded to study outcomes. Hazard ratio (95% CI) for 5-year kidney failure in patients in the ARB group was estimated. Kidney failure was defined as receipt of kidney replacement therapy or persistent drop in baseline estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73m2.Results: Matched patients had mean age 71 years, ejection fraction 44%, eGFR 70 mL/min/1.73m2, 97% were male, 18% African American, 23% received ACEIs or ARBs in high doses, and were balanced on 76 baseline characteristics. Kidney failure occurred in 4.4% (1961/44,089) and 5.4% (2389/44,089) of the patients in the ACEI and ARB groups, respectively. When accounted for the competing risk of death, patients in the ARB group had a 20% (95% CI, 13-28%) higher risk of kidney failure, which was similar in low-dose and high-dose subgroups. The associated risk of death was 5% (95% CI, 3-7%) lower in the ARB group, which was only significant in the low-dose group (7% vs 0%; interaction p, 0.007).Conclusion: In patients with heart failure, ARBs (vs. ACEIs) are associated with a higher risk of incident kidney failure. These findings need to be confirmed in future clinical trials.","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Higher Risk of Kidney Failure Associated with Angiotensin Receptor Blockers Versus ACE Inhibitors in Patients with Heart Failure.\",\"authors\":\"Hans J Moore, Wen-Chih Wu, Paul A Heidenreich, Patrick Rossignol, Samir S Patel, Frederick Lu, Phillip H Lam, Amiya A Ahmed, Charles Faselis, Javed Butler, Carlos E Palant, Bertram Pitt, Matthew R Weir, Prakash Deedwania, David Atkins, Venkatesh K Raman, Janani Rangaswami, Jose D Vargas, Sijian Zhang, Charity J Morgan, Helen M Sheriff, Qing Zeng-Treitler, Gregg C Fonarow, Ali Ahmed\",\"doi\":\"10.1016/j.amjmed.2025.05.024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Renin-angiotensin system (RAS) inhibition with angiotensin-covering enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is associated with a lower risk of kidney failure in patients with heart failure. We examined whether this association varies between ACEIs and ARBs.Methods: From 300,361 Veterans with heart failure without kidney failure initiated on ACEIs (n=256,224) or ARBs (n=44,137), we assembled a propensity score-matched cohort of 88,178 patients while remaining blinded to study outcomes. Hazard ratio (95% CI) for 5-year kidney failure in patients in the ARB group was estimated. Kidney failure was defined as receipt of kidney replacement therapy or persistent drop in baseline estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73m2.Results: Matched patients had mean age 71 years, ejection fraction 44%, eGFR 70 mL/min/1.73m2, 97% were male, 18% African American, 23% received ACEIs or ARBs in high doses, and were balanced on 76 baseline characteristics. Kidney failure occurred in 4.4% (1961/44,089) and 5.4% (2389/44,089) of the patients in the ACEI and ARB groups, respectively. When accounted for the competing risk of death, patients in the ARB group had a 20% (95% CI, 13-28%) higher risk of kidney failure, which was similar in low-dose and high-dose subgroups. The associated risk of death was 5% (95% CI, 3-7%) lower in the ARB group, which was only significant in the low-dose group (7% vs 0%; interaction p, 0.007).Conclusion: In patients with heart failure, ARBs (vs. ACEIs) are associated with a higher risk of incident kidney failure. These findings need to be confirmed in future clinical trials.\",\"PeriodicalId\":50807,\"journal\":{\"name\":\"American Journal of Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-05-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amjmed.2025.05.024\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjmed.2025.05.024","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

摘要

背景：血管紧张素覆盖酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）抑制肾素-血管紧张素系统（RAS）与心力衰竭患者肾功能衰竭的风险降低有关。我们研究了这种关联在acei和arb之间是否有所不同。方法：从300,361名开始服用acei （n=256,224）或arb （n=44,137）的心力衰竭无肾衰竭退伍军人中，我们收集了一个倾向评分匹配的队列，其中有88178名患者，同时对研究结果保持盲法。评估ARB组患者5年肾衰竭的风险比（95% CI）。肾衰竭定义为接受肾脏替代治疗或基线肾小球滤过率（eGFR）持续下降至2。结果：匹配的患者平均年龄71岁，射血分数44%，eGFR 70 mL/min/1.73m2, 97%为男性，18%为非洲裔美国人，23%接受高剂量acei或arb治疗，76个基线特征平衡。ACEI组和ARB组肾衰竭发生率分别为4.4%（1961/ 44089）和5.4%（2389/ 44089）。当考虑到竞争死亡风险时，ARB组患者发生肾衰竭的风险高出20% (95% CI, 13-28%)，这在低剂量和高剂量亚组中相似。ARB组的相关死亡风险降低5% (95% CI, 3-7%)，仅在低剂量组显著(7% vs 0%；交互作用p， 0.007)。结论：在心力衰竭患者中，arb（与acei相比）与更高的突发肾衰竭风险相关。这些发现需要在未来的临床试验中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Higher Risk of Kidney Failure Associated with Angiotensin Receptor Blockers Versus ACE Inhibitors in Patients with Heart Failure.

Background: Renin-angiotensin system (RAS) inhibition with angiotensin-covering enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is associated with a lower risk of kidney failure in patients with heart failure. We examined whether this association varies between ACEIs and ARBs.

Methods: From 300,361 Veterans with heart failure without kidney failure initiated on ACEIs (n=256,224) or ARBs (n=44,137), we assembled a propensity score-matched cohort of 88,178 patients while remaining blinded to study outcomes. Hazard ratio (95% CI) for 5-year kidney failure in patients in the ARB group was estimated. Kidney failure was defined as receipt of kidney replacement therapy or persistent drop in baseline estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73m².

Results: Matched patients had mean age 71 years, ejection fraction 44%, eGFR 70 mL/min/1.73m², 97% were male, 18% African American, 23% received ACEIs or ARBs in high doses, and were balanced on 76 baseline characteristics. Kidney failure occurred in 4.4% (1961/44,089) and 5.4% (2389/44,089) of the patients in the ACEI and ARB groups, respectively. When accounted for the competing risk of death, patients in the ARB group had a 20% (95% CI, 13-28%) higher risk of kidney failure, which was similar in low-dose and high-dose subgroups. The associated risk of death was 5% (95% CI, 3-7%) lower in the ARB group, which was only significant in the low-dose group (7% vs 0%; interaction p, 0.007).

Conclusion: In patients with heart failure, ARBs (vs. ACEIs) are associated with a higher risk of incident kidney failure. These findings need to be confirmed in future clinical trials.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

American Journal of Medicine 医学-医学：内科

CiteScore

6.30

自引率

3.40%

发文量

449

审稿时长

9 days

期刊介绍： The American Journal of Medicine - "The Green Journal" - publishes original clinical research of interest to physicians in internal medicine, both in academia and community-based practice. AJM is the official journal of the Alliance for Academic Internal Medicine, a prestigious group comprising internal medicine department chairs at more than 125 medical schools across the U.S. Each issue carries useful reviews as well as seminal articles of immediate interest to the practicing physician, including peer-reviewed, original scientific studies that have direct clinical significance and position papers on health care issues, medical education, and public policy.