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Article: Long-term outcomes of add-on direct renin inhibition in igA nephropathy: a propensity score-matched cohort study
Title | Long-term outcomes of add-on direct renin inhibition in igA nephropathy: a propensity score-matched cohort study |
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Authors | |
Keywords | Aliskiren Chronic kidney disease Cohort study Direct renin inhibitor Immunoglobulin A nephropathy |
Issue Date | 1-Mar-2023 |
Publisher | Springer |
Citation | Journal of Nephrology, 2023, v. 36, n. 2, p. 407-416 How to Cite? |
Abstract | IntroductionThe long-term clinical outcomes in biopsy proven IgAN patients treated with aliskiren on top of a maximally tolerated dose of ACEi/ARB remain unknown. MethodsPatients with IgAN treated with a direct renin inhibitor and ACEi/ARB for at least 6 months were compared with a 1:1 propensityscore-matched cohort (including MEST-C score and the 12-months pre-exposure slope of eGFR matching) who received ACEi/ARB without aliskiren exposure to compute the hazard ratio of reaching the primary endpoint of a composite of 40% reduction in eGFR, initiation of KRT and all-cause mortality. Secondary outcome measures included changes in mean UPCR, blood pressure, eGFR, incidence of hyperkalemia and other adverse events during follow-up. ResultsAfter a median follow-up of 2.5 years, 8/36 (22.2%) aliskiren-treated patients and 6/36 (16.7%) control patients reached the primary composite outcome (HR = 1.60; 95% CI 0.52–4.88; P = 0.412). Aliskiren treatment increased the risk of ≥ 40% eGFR decline (HR = 1.60; 95% CI 0.52–4.88; P = 0.412), and hyperkalemia (HR = 8.60; 95% CI 0.99–73.64; P = 0.050). At 10.8 years, renal composite outcome was reached in 69.4% vs 58.3% (HR = 2.16; 95% CI 1.18–3.98; P = 0.013) of patients in the aliskiren and control groups, respectively. The mean UPCR reduction between treatment and control was not statistically different (52.7% vs 42.5%; 95% CI 0.63–2.35; P = 0.556). The mean intergroup difference in eGFR decline over 60 months was 7.75 ± 3.95 ml/min/1.73 m2 greater in the aliskiren group (12.83 vs 5.08; 95% CI − 0.17 to 15.66; P = 0.055). ConclusionAmong patients with IgAN, add-on aliskiren was associated with less favorable long-term kidney outcomes despite an initial anti-proteinuric effect. |
Persistent Identifier | http://hdl.handle.net/10722/338819 |
ISSN | 2023 Impact Factor: 2.7 2023 SCImago Journal Rankings: 0.843 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Lie, Davina N W | - |
dc.contributor.author | Chan, Kam Wa | - |
dc.contributor.author | Tang, Alexander H N | - |
dc.contributor.author | Chan, Anthony T P | - |
dc.contributor.author | Chan, Gary C W | - |
dc.contributor.author | Lai, Kar Neng | - |
dc.contributor.author | Tang, Sydney Chi-Wai | - |
dc.date.accessioned | 2024-03-11T10:31:47Z | - |
dc.date.available | 2024-03-11T10:31:47Z | - |
dc.date.issued | 2023-03-01 | - |
dc.identifier.citation | Journal of Nephrology, 2023, v. 36, n. 2, p. 407-416 | - |
dc.identifier.issn | 1121-8428 | - |
dc.identifier.uri | http://hdl.handle.net/10722/338819 | - |
dc.description.abstract | <h3>Introduction</h3><p>The long-term clinical outcomes in biopsy proven IgAN patients treated with aliskiren on top of a maximally tolerated dose of ACEi/ARB remain unknown.</p><h3>Methods</h3><p>Patients with IgAN treated with a direct renin inhibitor and ACEi/ARB for at least 6 months were compared with a 1:1 propensityscore-matched cohort (including MEST-C score and the 12-months pre-exposure slope of eGFR matching) who received ACEi/ARB without aliskiren exposure to compute the hazard ratio of reaching the primary endpoint of a composite of 40% reduction in eGFR, initiation of KRT and all-cause mortality. Secondary outcome measures included changes in mean UPCR, blood pressure, eGFR, incidence of hyperkalemia and other adverse events during follow-up.</p><h3>Results</h3><p>After a median follow-up of 2.5 years, 8/36 (22.2%) aliskiren-treated patients and 6/36 (16.7%) control patients reached the primary composite outcome (HR = 1.60; 95% CI 0.52–4.88; <em>P</em> = 0.412). Aliskiren treatment increased the risk of ≥ 40% eGFR decline (HR = 1.60; 95% CI 0.52–4.88; <em>P</em> = 0.412), and hyperkalemia (HR = 8.60; 95% CI 0.99–73.64; <em>P</em> = 0.050). At 10.8 years, renal composite outcome was reached in 69.4% vs 58.3% (HR = 2.16; 95% CI 1.18–3.98; <em>P</em> = 0.013) of patients in the aliskiren and control groups, respectively. The mean UPCR reduction between treatment and control was not statistically different (52.7% vs 42.5%; 95% CI 0.63–2.35; <em>P</em> = 0.556). The mean intergroup difference in eGFR decline over 60 months was 7.75 ± 3.95 ml/min/1.73 m<sup>2</sup> greater in the aliskiren group (12.83 vs 5.08; 95% CI − 0.17 to 15.66; <em>P</em> = 0.055).</p><h3>Conclusion</h3><p>Among patients with IgAN, add-on aliskiren was associated with less favorable long-term kidney outcomes despite an initial anti-proteinuric effect.</p> | - |
dc.language | eng | - |
dc.publisher | Springer | - |
dc.relation.ispartof | Journal of Nephrology | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Aliskiren | - |
dc.subject | Chronic kidney disease | - |
dc.subject | Cohort study | - |
dc.subject | Direct renin inhibitor | - |
dc.subject | Immunoglobulin A nephropathy | - |
dc.title | Long-term outcomes of add-on direct renin inhibition in igA nephropathy: a propensity score-matched cohort study | - |
dc.type | Article | - |
dc.identifier.doi | 10.1007/s40620-022-01530-7 | - |
dc.identifier.scopus | eid_2-s2.0-85146093200 | - |
dc.identifier.volume | 36 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 407 | - |
dc.identifier.epage | 416 | - |
dc.identifier.eissn | 1724-6059 | - |
dc.identifier.isi | WOS:000912295500001 | - |
dc.identifier.issnl | 1121-8428 | - |