Related Experiment Video
Updated: Dec 23, 2025
06:10
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
3.5K
Longer Predialysis ACEi/ARB Utilization Is Associated With Reduced Postdialysis Mortality
Elvira O Gosmanova1, Miklos Z Molnar2, Adnan Naseer3
1Nephrology Section, Stratton VA Medical Center, Albany, New York; Division of Nephrology, Department of Medicine, Albany Medical College, Albany, New York.
The American Journal of Medicine
|April 25, 2020
Summary
Longer use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) before dialysis is linked to better survival after starting dialysis. Continuous ACEi/ARB use also reduced risks of acute kidney injury and hyperkalemia.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) improve predialysis outcomes.
- ACEi/ARB are underused in patients transitioning to dialysis.
- Association between predialysis ACEi/ARB use patterns and postdialysis outcomes is unclear.
Purpose of the Study:
- Examine the association of predialysis ACEi/ARB use patterns with postdialysis survival.
- Investigate if modifiable adverse events are linked to lower predialysis ACEi/ARB use.
Main Methods:
- Historic cohort study of 34,676 US veterans transitioning to dialysis.
- Compared ACEi/ARB exposure vs. non-exposure in the 3-year predialysis period.
- Used multivariable adjusted regression analyses for mortality, acute kidney injury, and hyperkalemia.
Main Results:
- Continuous ACEi/ARB use was associated with lower postdialysis all-cause mortality (aHR 0.87; 95% CI 0.83-0.92).
- ACEi/ARB use of 50%-74% and ≥75% were associated with lower mortality compared to nonuse.
- Shorter ACEi/ARB use (<50%) linked to predialysis acute kidney injury; interrupted use linked to hyperkalemia.
Conclusions:
- Longer predialysis ACEi/ARB exposure is associated with reduced postdialysis mortality.
- Strategies promoting uninterrupted predialysis ACEi/ARB use warrant further investigation.
- Optimizing ACEi/ARB use before dialysis may improve patient outcomes.
Keywords:
Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB)DialysisEnd-stage kidney disease (ESKD)MortalityVeteransMore Related Videos
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
811
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
811
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
2.2K
Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
2.2K
01:25Antihypertensive Drugs: Direct Renin Inhibitors
1.1K
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
1.1K
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
2.2K
In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
2.2K
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
210
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
210
01:30Heart Failure V: Medical Management
159
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
159