The following is a summary of “Cardiovascular Outcomes of Renin-Angiotensin System Inhibition Amongst Non-Proteinuric Chronic Kidney Disease Patients in the Chronic Renal Insufficiency Cohort,” published in the November 2023 issue of Cardiology by Shulman et al.

While chronic kidney disease (CKD) fuels CVD, most patients lack proteinuria, leaving them without clear therapy options beyond the proteinuric-specific benefits of renin-angiotensin system (RAS) blockers.

Researchers conducted a retrospective investigation to determine if RAS blockade impacts long-term cardiovascular outcomes and survival in non-proteinuric CKD patients.

They first conducted a study on subjects from the Chronic Renal Insufficiency Cohort Study without proteinuria. Non-proteinuric CKD was defined as urine protein <0.5g/day. Subjects with heart failure or those not on hypertension treatment were excluded. Analyzed with Cox regression to link RAS blockade and other antihypertensive drugs to CVD events and mortality. The main outcome was a composite of physician-adjudicated CVD events, such as MI, stroke, heart failure, hospitalization, and death. Adjusted for baseline factors like age, sex, race, smoking, and health behaviors using inverse probability weighting.

The results showed 2,825 subjects, with 2,068 subjects (73%) using RAS blockade, while 757 (27%) did not. Users and non-users had similar age (61 vs. 62 years) and eGFR (50 vs. 51 ml/min/1.73m²). Users were more likely to be male (66% vs. 46%), have diabetes (59% vs. 30%), and be on a statin (61% vs. 50%). There was no significant association between RAS blockade and CVD events (adjusted HR 0.90, 95% CI 0.76-1.07) or mortality (aHR 0.84, 95% CI 0.68-1.04) compared to other antihypertensive therapy.

They concluded that in non-proteinuric CKD, RAS blockade did not translate to long-term cardiovascular benefits, warranting further investigation in high-risk subgroups.

Source: ahajournals.org/doi/10.1161/circ.148.suppl_1.16652