Kidney Week

Abstract: TH-PO1063

Effect of the RAS Inhibitors on Kidney Outcomes in Patients with Advanced CKD: A Systematic Review and Meta-Analysis

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

• Jintanapramote, Kavita, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand

Kavita Jintanapramote, MD

• Leevongsakorn, Rathanon, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand

Rathanon Leevongsakorn, MD

• Chuasuwan, Anan, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand

Anan Chuasuwan, MD, PhD

Background

Chronic kidney disease (CKD) is a global health concern, with Renin-Angiotensin System inhibitors (RASi) playing a crucial role in slowing CKD progression. However, the efficacy and safety of advanced CKD (eGFR <30 ml/min per 1.73 m²) are still controversial. This study aims to evaluate the impact of RASi on kidney function and outcomes in this specific population.

Methods

We conducted a literature search in MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials until September 2023 in search of studies comparing the effects of receiving RASi versus non-receiving RASi in advanced CKD patients on kidney progression, all-cause mortality, major adverse cardiovascular events (MACEs), hyperkalemia, and heart failure.

Results

A total of ten studies, including 60,212 participants, were included. Analysis revealed no statistically significant difference in kidney progression [risk ratio (RR) 1.08 (95% CI: 0.95-1.23)] or MACEs [RR 0.95 (95% CI: 0.81–1.0)] between receiving RASi and non-receiving RASi. However, a significant decrease in all-cause mortality was observed in patients receiving RASi [RR 0.88 (95% CI: 0.79–0.98)]. Conversely, the analysis indicated a significant increase in adverse events in RASi usage, including hyperkalemia [RR 1.29 (95% CI: 1.15–1.43)] and heart failure [RR 1.35 (95% CI: 1.16–1.56)].

Conclusion

The use of RASi in advanced CKD has shown benefits in reducing all-cause mortality without exacerbating kidney disease progression. However, employing RASi may also lead to complications such as hyperkalemia and potential heart failure, necessitating caution and diligent monitoring.