PDF(Pubmed)
Abstract：
UNASSIGNED: Limited evidence exists regarding the cumulative dosing and duration impact of renin-angiotensin system inhibitors (RASis) on cardiorenal and mortality outcomes in patients with advanced stages (predominantly in stage 5 and a minority in stage 4) of diabetic kidney disease (DKD).
UNASSIGNED: To retrospectively investigate whether there are dose- and time-dependent relationships between RASis and cardiorenal and mortality outcomes in this population.
UNASSIGNED: Using Taiwan\'s national health insurance data in 2000-2017, we analyzed 2196 RASi users and 2196 propensity-matched nonusers among 8738 patients living with diabetes and newly diagnosed with advanced chronic kidney disease (23% stage 4, 77% stage 5). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% CI.
UNASSIGNED: RASi use was significantly associated with reduced risks of all-cause mortality (aHR, 0.53; 95% CI 0.47-0.60) and cardiovascular mortality (0.68; 0.56-0.83) with the degree of benefit depending on therapeutic dosage and duration, despite a nonsignificant increase in acute kidney injury risk (1.16; 0.98-1.38) and a significant increase in hyperkalemia risk (1.45; 1.19-1.77). Significant differences in proteinuria risk (1.32; 1.21-1.43) were observed, while there were no significant differences in end-stage renal disease risk (1.01; 0.88-1.15) and no dose- or time-response relationships for either end-stage renal disease or proteinuria risks. Sensitivity analyses confirmed cardiovascular and survival benefits, even in patients with stage 5 DKD.
UNASSIGNED: This real-world study suggests that RASi use in advanced stages 4 to 5 DKD may provide dose- and time-dependent cardioprotection and improved survival, without excess renal harms.
UNASSIGNED: To retrospectively investigate whether there are dose- and time-dependent relationships between RASis and cardiorenal and mortality outcomes in this population.
UNASSIGNED: Using Taiwan\'s national health insurance data in 2000-2017, we analyzed 2196 RASi users and 2196 propensity-matched nonusers among 8738 patients living with diabetes and newly diagnosed with advanced chronic kidney disease (23% stage 4, 77% stage 5). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% CI.
UNASSIGNED: RASi use was significantly associated with reduced risks of all-cause mortality (aHR, 0.53; 95% CI 0.47-0.60) and cardiovascular mortality (0.68; 0.56-0.83) with the degree of benefit depending on therapeutic dosage and duration, despite a nonsignificant increase in acute kidney injury risk (1.16; 0.98-1.38) and a significant increase in hyperkalemia risk (1.45; 1.19-1.77). Significant differences in proteinuria risk (1.32; 1.21-1.43) were observed, while there were no significant differences in end-stage renal disease risk (1.01; 0.88-1.15) and no dose- or time-response relationships for either end-stage renal disease or proteinuria risks. Sensitivity analyses confirmed cardiovascular and survival benefits, even in patients with stage 5 DKD.
UNASSIGNED: This real-world study suggests that RASi use in advanced stages 4 to 5 DKD may provide dose- and time-dependent cardioprotection and improved survival, without excess renal harms.
摘要：
■关于肾素-血管紧张素系统抑制剂（RASis）对糖尿病肾病（DKD）晚期（主要在5期，少数在4期）患者的心肾和死亡率结局的累积剂量和持续时间影响的证据有限。
■回顾性调查该人群的RAS与心肾结局和死亡率之间是否存在剂量和时间依赖性关系。
■使用台湾2000-2017年的国民健康保险数据，我们分析了8738例糖尿病患者和新诊断为晚期慢性肾脏病的患者中的2196名RASi使用者和2196名倾向匹配的非使用者（23％的4期，77％的5期）。Cox比例风险回归模型用于估计校正风险比(aHRs)和95%CI。
■使用RASi与全因死亡率风险降低显著相关(aHR，0.53;95%CI0.47-0.60)和心血管死亡率(0.68;0.56-0.83)，获益程度取决于治疗剂量和持续时间，尽管急性肾损伤风险无显著增加(1.16;0.98-1.38),高钾血症风险显著增加(1.45;1.19-1.77).观察到蛋白尿风险的显着差异（1.32;1.21-1.43），而终末期肾病风险无显著差异(1.01;0.88-1.15),且终末期肾病或蛋白尿风险均无剂量-反应或时间-反应关系.敏感性分析证实了心血管和生存益处，即使是5期DKD患者。
■这项现实世界的研究表明，在晚期4至5DKD中使用RASi可能会提供剂量和时间依赖性的心脏保护作用，并改善生存率，没有过多的肾脏损害。
■回顾性调查该人群的RAS与心肾结局和死亡率之间是否存在剂量和时间依赖性关系。
■使用台湾2000-2017年的国民健康保险数据，我们分析了8738例糖尿病患者和新诊断为晚期慢性肾脏病的患者中的2196名RASi使用者和2196名倾向匹配的非使用者（23％的4期，77％的5期）。Cox比例风险回归模型用于估计校正风险比(aHRs)和95%CI。
■使用RASi与全因死亡率风险降低显著相关(aHR，0.53;95%CI0.47-0.60)和心血管死亡率(0.68;0.56-0.83)，获益程度取决于治疗剂量和持续时间，尽管急性肾损伤风险无显著增加(1.16;0.98-1.38),高钾血症风险显著增加(1.45;1.19-1.77).观察到蛋白尿风险的显着差异（1.32;1.21-1.43），而终末期肾病风险无显著差异(1.01;0.88-1.15),且终末期肾病或蛋白尿风险均无剂量-反应或时间-反应关系.敏感性分析证实了心血管和生存益处，即使是5期DKD患者。
■这项现实世界的研究表明，在晚期4至5DKD中使用RASi可能会提供剂量和时间依赖性的心脏保护作用，并改善生存率，没有过多的肾脏损害。
