RAS Blockade Treatment in ADPKD Patients on Dialysis

In the general population and among patients at high risk for cardiovascular disease, renin-angiotensin system (RAS) blockade is known to reduce cardiovascular disease, However, according to Chien-Lin Lu, MD, et al., there are few data available on the protective effects of RAS inhibitors in patients with autosomal dominant polycystic kidney disease (ADPKD) on dialysis.

Dr. Lu and colleagues used the data from the 1995 to 2008 Taiwan National Health Insurance Research Database (Registry for Catastrophic Illnesses) to examine adjusted hazard ratios for all-cause mortality and cardiovascular disease events in users and nonusers of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) during 12 years of follow-up. Results were reported online in Medicine [2021;100(26):e26559].

The study cohort included 387 patients with ADPKD ≥18 years of age who received dialysis therapy and had no evidence of cardiovascular events in 1997 and 1998. Of the 387 patients, 231 were users of ACEi/ARB and 156 were nonusers (control). Cox proportional regression analysis and propensity score matching were used to evaluate adjusted hazard ratios for all-cause mortality and cardiovascular events. All participants were followed for >3 months.

There was no significant difference between the group treated with ACEi/ARB and the control group in incident cardiovascular disease events with the exception of ischemic stroke and transient ischemic accident. Following propensity score matching, results were similar. In addition, after propensity score matching, there was no significant difference in outcomes between ACEi/ARB treatment over 50% of the follow-up period and no ACEi/ARB treatment.

“This nationwide cohort study failed to prove the protective effects of long-term ACEi or ARB on incident cardiovascular disease events among ADPKD dialysis patients. Further larger scale, multicenter, and randomized control trials are warranted to show the causal association,” the authors said.