Vejakama P, et al. - Efficacy of renin angiotensin aldosterone system (RAAS) blockade on chronic kidney disease (CKD) progression was investigated in this study. It was observed that both CKD progression to end-stage renal disease (ESRD) and premature mortality could be prevented with RAAS blockade for 1 year or longer.

Methods

• From 1997 to 2011, a retrospective CKD cohort was conducted at Ubon Ratchathani province, Thailand.
• ESRD was defined as estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2, dialysis, or kidney transplantation.
• Until December 31, 2011, verification of all-cause mortality was carried out.
• The effectiveness of RAAS blockade on outcomes, i.e., ESRD, death before and after ESRD was determined by applying a counterfactual-framework.
• According to duration of use <0.25 year, 0.25–1 year (RAAS1), and >1 year (RAAS2), the categorization of RAAS blockade was done.
• Furthermore, potential-outcome mean (POM) and average treatment-effect (ATE) were estimated using an augmented inverse-probability weighting (AIPW) method.
• Researchers used multi-logit and Poisson regressions for treatment and outcome models, respectively.
• They also performed stratification of analyses by ESRD, death before/after ESRD for diabetic and non-diabetic groups.
• For statistical analyses, they used STATA 14.0.

Results

• Among 15,032 diabetic patients, ESRD, death before ESRD and death after ESRD was reported in 2346 (15.6%), 2351 (18.5%), and 1607 (68.5%), respectively.
• Data showed that only RAAS2 impact was significant on ESRD, death before and after ESRD.
• Findings also demonstrated that the ESRD rates were 12.9%, vs 20.0% for RAAS2 and non-RAAS, respectively, resulted in significant risk differences (RD) of -7.2% (95% CI: -8.8%, -5.5%), and a numbers needed-to-treat (NNT) of 14.
• Researchers found that death rates before ESRD for these corresponding groups were 14.4% (12.9%, 15.9%) and 19.6% (18.7%, 20.4%) with a NNT of 19.
• They also noted that in RAAS2 vs non-RASS group, death rates after ESRD was lower (i.e., 62.8% (55.5%, 68.9%) vs 68.1% (65.9%, 70.4%)) but this was not significant.
• In addition, data showed that RAAS2 effects on ESRD and death before ESRD were persistently significant in non-diabetic patients (n = 17,074) but not for death after ESRD with the NNT of about 15 and 16 respectively.