ACEI/ARB疗法与晚期慢性肾病冠心病患者的总死亡和心血管死亡的关系：一项大型多中心纵向研究。

IF 3 3区医学 Q1 UROLOGY & NEPHROLOGY Renal Failure Pub Date : 2024-12-01 Epub Date: 2024-09-04 DOI:10.1080/0886022X.2024.2398189

Wenguang Lai, Xiaoli Zhao, Tingting Zhang, Donghui Huang, Guoxiao Liang, Yang Zhou, Jin Liu, Shiqun Chen, Yong Liu

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引用次数: 0

摘要

简介：晚期慢性肾脏病（CKD）在冠状动脉疾病（CAD）患者中很常见，血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）可以改善心功能和肾功能，但ACEI/ARB治疗是否能改善这些高危患者的长期预后仍不清楚。因此，本研究旨在探讨 ACEI/ARB 治疗与患有晚期 CKD 的 CAD 患者的长期预后之间的关系：方法：纳入五家医院的 CAD 晚期 CKD 患者。晚期 CKD 的定义是估计肾小球滤过率（eGFR）2。采用 Cox 回归模型和竞争风险 Fine 和 Gray 模型分别研究 ACEI/ARB 治疗与全因死亡和心血管死亡之间的关系：在2527名患者中，47.6%的患者在出院时使用了ACEI/ARB。全因死亡率和心血管死亡率分别为 38.6% 和 24.7%。多变量 Cox 回归分析表明，ACEI/ARB 治疗与较低的全因死亡率（危险比 (HR)=0.836, 95% 置信区间 (CI): 0.738-0.948, p = 0.005）和心血管死亡率（HR = 0.817, 95%CI: 0.699-0.956, p = 0.011）相关。在倾向匹配队列中，生存获益是一致的，在接受 ACEI/ARB 治疗的患者中，观察到全因死亡率（HR = 0.856，95%CI：0.752-0.974，p = 0.019）和心血管死亡率（HR = 0.830，95%CI：0.707-0.974，p = 0.023）的生存率显著提高：ACEI/ARB疗法在晚期CKD高危CAD患者的长期随访中显示出更好的生存获益，这表明维持ACEI/ARB治疗的策略可能会改善这些高危人群的临床预后。

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Association of ACEI/ARB therapy with total and cardiovascular death in coronary artery disease patients with advanced chronic kidney disease: a large multi-center longitudinal study.

Introduction: Advanced chronic kidney disease (CKD) is common among patients with coronary artery disease (CAD), and angiotensin‑converting enzyme inhibitors (ACEI) or angiotensin‑receptor blockers (ARB) can improve cardiac and renal function, but whether ACEI/ARB therapy improves long-term prognosis remains unclear among these high-risk patients. Therefore, this research aimed to investigate the relationship between ACEI/ARB therapy and long-term prognosis among CAD patients with advanced CKD.

Methods: CAD patients with advanced CKD were included in five hospitals. Advanced CKD was defined as estimated glomerular filtration rate (eGFR)<30 ml/min per 1.73 m². Cox regression models and competing risk Fine and Gray models were used to examine the relationship between ACEI/ARB therapy and all-cause and cardiovascular death, respectively.

Results: Of 2527 patients, 47.6% population of our cohort was discharged on ACEI/ARB. The overall all-cause and cardiovascular mortality were 38.6% and 24.7%, respectively. Multivariate Cox regression analyses indicated that ACEI/ARB therapy was found to be associated with lower rates of both all-cause mortality (hazard ratio (HR)=0.836, 95% confidence interval (CI): 0.738-0.948, p = 0.005) and cardiovascular mortality (HR = 0.817, 95%CI: 0.699-0.956, p = 0.011). In the propensity-matched cohort, the survival benefit was consistent, and significantly better survival was observed for all-cause mortality (HR = 0.856, 95%CI: 0.752-0.974, p = 0.019) and cardiovascular mortality (HR = 0.830, 95%CI: 0.707-0.974, p = 0.023) among patients treated with ACEI/ARB.

Conclusion: ACEI/ARB therapy showed a better survival benefit among high-risk CAD patients with advanced CKD at long-term follow-up, which manifested that strategies to maintain ACEI/ARB treatment may improve clinical outcomes among these high-risk populations.

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来源期刊

Renal Failure 医学-泌尿学与肾脏学

CiteScore

3.90

自引率

13.30%

发文量

374

审稿时长

1 months

期刊介绍： Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.