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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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/1.73m<sup>2</sup>.</p><p><strong>Results: </strong>Matched patients had mean age 71 years, ejection fraction 44%, eGFR 70 mL/min/1.73m<sup>2</sup>, 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).</p><p><strong>Conclusion: </strong>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.</p>","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\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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/1.73m<sup>2</sup>.</p><p><strong>Results: </strong>Matched patients had mean age 71 years, ejection fraction 44%, eGFR 70 mL/min/1.73m<sup>2</sup>, 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).</p><p><strong>Conclusion: </strong>In patients with heart failure, ARBs (vs. ACEIs) are associated with a higher risk of incident kidney failure. 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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.
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.