title: Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the International Scleroderma Renal Crisis Survey.
abstract: OBJECTIVE
  To determine whether exposure to angiotensin-converting enzyme (ACE) inhibitors prior to the onset of scleroderma renal crisis (SRC) leads to worse outcomes of SRC.
  
  
  METHODS
  Prospective cohort study of incident SRC subjects. The exposure of interest was ACE inhibitors prior to the onset of SRC. The outcomes of interest were death or dialysis during the first year after the onset of SRC.
  
  
  RESULTS
  A total of 87 subjects with incident SRC were identified and 1-year follow-up data were obtained in 75 (86%) subjects. Overall, 27 (36%) subjects died within the first year and an additional 19 (25%) remained on dialysis 1 year after the onset of SRC. In adjusted analyses, exposure to ACE inhibitors prior to the onset of SRC was associated with an increased risk of death (hazard ratio 2.42, 95% CI 1.02, 5.75, p < 0.05 in the primary analysis and 2.17, 95% CI 0.88, 5.33, p = 0.09 after post-hoc adjustment for pre-existing hypertension).
  
  
  CONCLUSIONS
  Overall, the 1-year outcomes of SRC were poor. Prior exposure to ACE inhibitors was associated with an increased risk of death after the onset of SRC, although there was uncertainty around the magnitude of the risk and the possibility of residual confounding could not be ruled out. Further studies will be needed to confirm these findings.
authors.affiliation: Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada. Electronic address: marie.hudson@mcgill.ca.
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.affiliation: Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.affiliation: Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Solène
authors.initials: S
authors.lastname: Tatibouet
authors.affiliation: Geffen School of Medicine, University of California, Los Angeles, CA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Furst
authors.affiliation: University of Michigan Scleroderma Program, Ann Arbor, MI.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012595:Scleroderma, Systemic / Q000150:complications*; D012720:Severity of Illness Index
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACE inhibitors; Scleroderma; Scleroderma renal crisis