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Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure

 Se Yong Jang  ;  Shung Chull Chae  ;  Myung Hwan Bae  ;  Jang Hoon Lee  ;  Dong Heon Yang  ;  Hun Sik Park  ;  Yongkeun Cho  ;  Hyun-Jai Cho  ;  Hae-Young Lee  ;  Byung-Hee Oh  ;  Jin-Oh Choi  ;  Eun-Seok Jeon  ;  Min-Seok Kim  ;  Sang Eun Lee  ;  Jae-Joong Kim  ;  Kyung-Kuk Hwang  ;  Myeong-Chan Cho  ;  Sang Hong Baek  ;  Seok-Min Kang  ;  Dong-Ju Choi  ;  Byung-Su Yoo  ;  Youngkeun Ahn  ;  Kye Hun Kim  ;  Hyun-Young Park 
 International Journal of Cardiology, Vol.266 : 180-186, 2018 
Journal Title
 International Journal of Cardiology 
Issue Date
Angiotensin receptor blocker ; Angiotensin-converting enzyme inhibitors ; Heart failure ; Renal insufficiency
BACKGROUND: Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure. METHODS AND RESULTS: Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40% and estimated glomerular filtration rate < 30 mL/min/1.73 m2 during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6%) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7% and 53.8% for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269-0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731-1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005). CONCLUSIONS: Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
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