FP405RENIN-ANGIOTENSIN SYSTEM INHIBITION, MORTALITY AND CARDIORENAL OUTCOMES IN ADVANCED CHRONIC KIDNEY DISEASE
Bibliographic record
Abstract
INTRODUCTION: The safety and efficacy of renin-angiotensin system inhibition (RASi) in patients with category G4-5 chronic kidney disease (CKD) is uncertain. These patients have been underrepresented in randomized controlled trials of RASi. METHODS: We studied clinically stable adults with G4-5 CKD (eGFR<30 ml/min per 1.73 m2), not on replacement therapy, without previous documented use of RASi, who had been in contact with health care in Stockholm, Sweden during 2007-2011. Initiation of RASi during follow-up was identified by pharmacy dispensations, and treated as a time-updated exposure in the Cox multivariable analysis. Analyses were adjusted for age, sex, eGFR, comorbidities and medication use. The primary outcome was all-cause mortality; secondary outcomes were major adverse cardiovascular events (MACE; composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke), renal replacement therapy (RRT), and incident hyperkalemia (plasma potassium >5.5 mmol/L). RESULTS: Among 6902 eligible patients (mean age 82 years, 41% men, mean eGFR 24 ml/min/1.73m2), 1243 (18%) initiated RASi. During a median follow-up of 2.1 years, a total of 4149 (60.1%) deaths, 2280 (33.0%) MACE, 1314 (19.0%) hyperkalemias and 113 (1.6%) RRT events were registered. Compared with no use, initiation of RASi was associated with lower risk of death (adjusted hazard ratio, 0.87; 95% CI 0.79-0.96), but not MACE (1.10; 95% CI 0.96-1.26). The risks of hyperkalemia (3.05; 95% CI 2.60-3.57) and RRT (1.90; 95% CI 1.22-2.97) was higher. Results were robust across subgroups of patients, including by sex, diabetes, heart failure or hypertension. CONCLUSIONS: In this healthcare-based study of patients with advanced CKD, initiation of RASi was associated with 13% lower mortality risk, but with higher risk of RRT and hyperkalemia. These results showing that RASi among these mostly elderly patients with advanced CKD may confer a survival benefit suggest that restricting the use of RASi in this vulnerable patient population may not be warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".