ACEi/ARBs may prevent death, kidney events in older adults after dialysis, but with caveat

The use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARB) appears to reduce the risk of all-cause mortality and major adverse kidney events (MAKE) in very old adults who underwent dialysis for acute kidney injury (AKI), suggests a study.

However, ACEi/ARB therapy tends to increase the risk of hypotension and hyperkalaemia.

Using TriNetX, the researchers obtained data in adults aged ≥85 years who underwent dialysis during hospitalization and discontinued dialysis upon discharge between 2012 and 2022. Those initiating ACEi/ARB within 90 days postdischarge were identified and propensity score-matched with controls.

Cox proportional hazards models were used in an emulated target trial analysis to assess outcomes, including mortality, MAKE, and major adverse cardiovascular events (MACE).

A total of 88,024 patients were identified. Of these, 3,637 were ACEi/ARB users who were then matched to 3,637 controls. The mean follow-up was 9.02 months.

ACEi/ARB therapy significantly correlated with a reduced risk of all-cause mortality (adjusted hazard ratio [aHR], 0.64; p<0.01) and MAKE (aHR, 0.63; p<0.01). On the other hand, MACE did not significantly differ between groups (aHR, 0.94; p=0.49).

The beneficial effect of ACEi/ARB therapy on MAKE was more noticeable among patients with hypertension. However, treatment with ACEi/ARB appeared to elevate the risk of hypotension (aHR, 1.38; p<0.01) and hyperkalaemia (aHR, 1.69; p<0.01).

“These findings support the cautious use of ACEi/ARB in this high-risk population,” the researchers said.