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Dihydropyridine Calcium Channel Blockers and Kidney Outcomes.
Blum, Matthew F; Surapaneni, Aditya; Chang, Alexander; Inker, Lesley A; Chen, Teresa K; Appel, Lawrence J; Shin, Jung-Im; Grams, Morgan E.
Afiliación
  • Blum MF; Division of Nephrology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. mblum@medicine.wisc.edu.
  • Surapaneni A; Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
  • Chang A; Medicine Institute, Geisinger Health, Danville, PA, USA.
  • Inker LA; Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
  • Chen TK; Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
  • Appel LJ; San Francisco VA Health Care System, San Francisco, CA, USA.
  • Shin JI; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Grams ME; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
J Gen Intern Med ; 39(10): 1880-1886, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38639831
ABSTRACT

BACKGROUND:

Early trials of dihydropyridine calcium channel blockers (DCCBs) suggest a detrimental effect on intraglomerular pressure and an association with albuminuria.

OBJECTIVE:

We sought to evaluate the associations of DCCB initiation with albuminuria and kidney failure with replacement therapy (KFRT) and to determine whether renin-angiotensin system (RAS) blockade modified these associations.

DESIGN:

We conducted a target trial emulation study using a new user, active comparator design and electronic health record data from Geisinger Health.

PARTICIPANTS:

We included patients without severe albuminuria or KFRT who were initiated on a DCCB or thiazide (active comparator) between January 1, 2004, and December 31, 2019. MAIN

MEASURES:

Using inverse probability of treatment weighting, we performed doubly robust Cox proportional hazards regression to estimate the association of DCCB initiation with incident severe albuminuria (urine albumin to creatinine ratio > 300 mg/g) and KFRT, overall and stratified by RAS blocker use. KEY

RESULTS:

There were 11,747 and 26,758 eligible patients initiating a DCCB and thiazide, respectively, with a weighted baseline mean age of 60 years, systolic blood pressure of 143 mm Hg, and eGFR of 86 mL/min/1.73 m2, and with a mean follow-up of 8 years. Compared with thiazides, DCCBs were significantly associated with the development of severe albuminuria (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.16-1.43), with attenuation of risk in the presence of RAS blockade (P for interaction < 0.001). The risk of KFRT was increased among patients without RAS blockade (HR, 1.66; 95% CI, 1.19-2.31), but not with RAS blockade (P for interaction = 0.005).

CONCLUSIONS:

DCCBs were associated with increased risk of albuminuria and, in the absence of RAS blockade, KFRT. These findings suggest coupling DCCB therapy with RAS blockade may mitigate adverse kidney outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Bloqueadores de los Canales de Calcio / Albuminuria Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Bloqueadores de los Canales de Calcio / Albuminuria Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos