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Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction

Clark, Hannah ; Krum, Henry ; Hopper, Ingrid

European journal of heart failure, 2014-01, Vol.16 (1), p.41-48 [Periódico revisado por pares]

Oxford, UK: John Wiley & Sons, Ltd

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Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction
Autor: Clark, Hannah ; Krum, Henry ; Hopper, Ingrid
Assuntos: Angiotensin receptor blocker ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Disease Progression ; Follow-Up Studies ; Global Health ; Glomerular Filtration Rate - drug effects ; Heart failure ; Humans ; Incidence ; Kidney - drug effects ; Mineralocorticoid receptor antagonists ; Prognosis ; RAAS inhibitors ; Renal impairment ; Renal Insufficiency - epidemiology ; Renal Insufficiency - etiology ; Renal Insufficiency - physiopathology ; Renin-Angiotensin System - drug effects ; Time Factors ; Ventricular Dysfunction, Left - drug therapy ; Ventricular Dysfunction, Left - physiopathology ; Worsening renal function
É parte de: European journal of heart failure, 2014-01, Vol.16 (1), p.41-48
Notas: ark:/67375/WNG-HM32LTCJ-R
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Descrição: Aims Impaired renal function is associated with worse clinical outcomes in patients with LV systolic dysfunction (LVSD) and heart failure. Renin–angiotensin–aldosterone system (RAAS) inhibitors provide clinical benefit in these settings and often worsen renal function. It is not clear whether worsening renal function (WRF) in patients exposed to these agents predicts a worse prognosis or merely reflects the pharmacological action of the drug on the kidney. Methods and results We performed a meta‐analysis of all RAAS inhibitor LVSD trials reporting on outcomes according to WRF (as per individual study definition) in both active intervention and placebo groups. Five major studies (SOLVD, SAVE, RALES, Val‐HeFT and EPHESUS) contributed, with 20 573 patients. Compared with placebo, RAAS inhibitors reduced all‐cause mortality overall [n = 20 573, relative risk ratio (RR) 0.91, 95% confidence interval (CI) 0.86–0.95, P = 0.0003], in the group with no WRF (n = 18 209, RR 0.91, 95% CI 0.83–0.99, P = 0.04), and in the WRF group (n = 2364, RR 0.72, 95% CI 0.62–0.84, P < 0.0001). Compared with no WRF, WRF was associated with increased all‐cause mortality; however, this was less in the RAAS inhibitor group (n = 8905, RR 1.22, 95% CI 1.10–1.36, P = 0.0003) than in the placebo group (n = 9304, RR 1.52, 95% CI 1.37–1.69, P < 0.00001). Conclusions WRF shortly after randomization is associated with worsened outcomes compared with no WRF; however, the reduction in all‐cause mortality associated with the use of RAAS inhibitors was significantly greater in the presence of WRF than in the no WRF group. Clinicians should not be deterred from using RAAS inhibitors in the setting of WRF.
Editor: Oxford, UK: John Wiley & Sons, Ltd
Idioma: Inglês

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Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction

Clark, Hannah ; Krum, Henry ; Hopper, Ingrid

Oxford, UK: John Wiley & Sons, Ltd

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