Real-World Dosing of RAASi are Associated With Risk of Adverse Events in CKD

MedicalResearch.com Interview with:

Lei Qin

Lei Qin

Lei Qin MS
Director, Health Economics and Payer Analytics
AstraZeneca

MedicalResearch.com: What is the background for this study?

Response: Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapies for patients with chronic kidney disease (CKD), but are commonly prescribed at suboptimal doses, which has been associated with worsening clinical outcomes. The objective of our study was to estimate the real-world associations between RAASi dose and adverse clinical outcomes in patients prescribed RAASi therapies with new-onset CKD in the UK.

MedicalResearch.com: What are the main findings? 

  • Risk of mortality and MACE were significantly greater for patients on <50% than those on ≥50% of ESC guideline recommended RAASi doses
  • Patients with <50% of ESC-recommended RAASi dose are significantly more likely to die or experience a MACE event during the follow-up than those on ≥50% of ESC guideline recommended RAASi doses 

MedicalResearch.com: What should readers take away from your report? 

  • This study highlights the clinical consequences of reduced RAASi dosing in CKD patients. It outlines the generalizability of ESC-recommended doses in heart failure to a CKD cohort
  • Our findings are consistent with previous research and suggest that treatment strategies that allow patients to maintain guideline-recommended RAASi dosing such as hyperkalemia management may improve patient outcomes in routine clinical practice

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The generalizability of findings in our research to other settings need to be validated with different real-world data sources.

MedicalResearch.com: Is there anything else you would like to add?

Response: Our study highlights the unmet need in CKD patients and the importance to keep them on guideline-recommended RAASi therapies to optimize patient outcomes. Doctors may face challenges in optimally prescribing RAASi when a patient experiences hyperkalemia, and previous approaches may have been only to adjust to a sub-optimal RAASi dose or discontinue the therapy. A new class of potassium binders to manage hyperkalemia could offer physicians another option in managing the RAASi doses of CKD patients with hyperkalemia.

Any disclosures?

I am an employee of AstraZeneca, which sponsored the study.

Citation:

Real-world dosing practices of renin-angiotensin-aldosterone system inhibitors are associated with risk of adverse clinical events in CKD patients     Abstract #FR-OR116

Session Title: Towards Better Medication Usage in Patients with CKD [OR1902-1]

 

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