Kidney Week

Abstract: TH-PO1064

Impact of Renin-Angiotensin-Aldosterone-System Inhibition on Advanced CKD: A Retrospective Observational Study

Session Information

• CKD: Therapeutic Advances
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Westermann, Lukas, Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Lukas Westermann, MD

• Nolde, Janis Marc, Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Janis Marc Nolde, MD, PhD

• Arnold, Frederic, Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Frederic Arnold, MD

• Welte, Thomas, Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Thomas Welte, MD

Background

Therapeutic renin-angiotensin-aldosterone system inhibition (RAASi) slows chronic kidney disease (CKD) progression in mild and moderate CKD, but was thought to be unfavorable in advanced CKD. In contrast, recent data from a randomized controlled trial demonstrated that RAASi does not modulate kidney function decline in advanced CKD. Due to limited real-world data, this study investigates effects of RAASi on kidney function decline in advanced CKD in a comparably large cohort.

Methods

This single-center retrospective observational study presents data from 951 individuals with advanced CKD (estimated glomerular filtration rate [eGFR] 15-30 ml/min/1.73 m²) treated with or without RAASi, incorporating 1.298 treatment intervals over a median follow-up period of 19 months (interquartile range: 8-44). The primary endpoint was defined as time to manifestation of ESRD (eGFR <15 ml/min/1.73 m²) and was analyzed using interval- and right-censored datasets. Patients receiving RAASi were compared to those not receiving RAASi using univariate and covariate-adjusted time-to-event analysis. Covariate-adjusted hazard ratios (HR) were estimated for covariates comprised of several discrete (sex, CKD diagnosis) and continuous variables (year of inclusion, age, eGFR, urin-protein-creatinine-ratio [UPCR], BMI, mean arterial pressure, hemoglobin and serum potassium), applying multivariate parametric regression models.

Results

Univariate time-to-event analysis revealed a statistically significant yet clinically negligible difference in the median time to ESRD between the RAASi vs. non-RAASi group (p<0.001), with 7.0 years [95% CI: 4-NA] vs. 7.19 years [95% CI: 5.62-NA], respectively. Covariate adjusted analysis did not confirm an association of RAASi and kidney function decline (HR 0.90 [95% CI: 0.65-1.24], p=0.506). Higher eGFR (HR 0.75 [95% CI: 0.72-0.78], p<0.001) was associated with slower kidney function decline. Increased UPCR (HR 1.18 [95% CI: 1.12-1.24], p<0.001) was associated with faster kidney function decline.

Conclusion

RAAS inhibition is not associated with slower kidney function decline in advanced CKD. This study supports the continuation of therapeutic RAAS inhibition in advanced CKD, if clinically indicated.

*FA and TW contributed equally.

Funding

• Government Support – Non-U.S.