High-dose RAS inhibitors reduce kidney failure risk in HF patients

Treatment with high-dose renin-angiotensin system (RAS) inhibitors result in a lower risk of kidney failure in patients with heart failure (HF), reports a study.

The researchers used propensity-score matching to identify 168,860 veterans with HF phenotyped by artificial intelligence who were balanced on 77 baseline characteristics and initiated on RAS inhibitors. They calculated the hazard ratio (HR) for 5-year kidney failure in high- vs low-dose RAS inhibitor groups, accounting for competing risk of death.

Kidney failure was defined as kidney replacement therapy or estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m².

New-onset kidney failure occurred in 4.1 percent (3,455/84,430) of patients in the low-dose RAS inhibitor group and in 3.5 percent (2,966/84,430) of those in the high-dose group (HR, 0.85, 95 percent confidence interval [CI], 0.81‒0.89).

For the eGFR subgroups, the HRs were 1.21 (95 percent CI, 1.08‒1.36) for ≥60 mL/min/1.73 m², 0.93 (95 percent CI, 0.82‒1.05) for 45‒59 mL/min/1.73 m², and 0.82 (95 percent CI, 0.77‒0.87) for 15‒44 mL/min/1.73 m². Similar associations were noted across ejection fraction subgroups. Notably, the risk of death was lower in the subgroup with ejection fraction ≤40 percent.

“This new information may help to inform future guideline recommendations and clinical practice regarding RAS inhibitor use in these patients,” the researchers said. “Future studies need to examine this association in those with normal kidney function.”