title: Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker use, and mortality in patients with chronic kidney disease.
abstract: OBJECTIVE
  The study objective was to assess the association between angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use and mortality in patients with chronic kidney disease (CKD).
  
  
  BACKGROUND
  There is insufficient evidence about the association of ACEI or ARBs with mortality in patients with CKD.
  
  
  METHODS
  A logistic regression analysis was used to calculate the propensity of ACEI/ARB initiation in 141,413 U.S. veterans with nondialysis CKD who were previously unexposed to ACEI/ARB treatment. We examined the association of ACEI/ARB administration with all-cause mortality in patients matched by propensity scores using the Kaplan-Meier method and Cox models in "intention-to-treat" analyses and in generalized linear models with binary outcomes and inverse probability of treatment weights in "as-treated" analyses.
  
  
  RESULTS
  The age of the patients at baseline was 75 ± 10 years, 8% of patients were black, and 22% were diabetic. ACEI/ARB administration was associated with a significantly lower risk of mortality both in the intention-to-treat analysis (hazard ratio: 0.81, 95% confidence interval: 0.78 to 0.84; p < 0.001) and the as-treated analysis with inverse probability of treatment weights (odds ratio: 0.37, 95% confidence interval: 0.34 to 0.41; p < 0.001). The association of ACEI/ARB treatment with lower risk of mortality was present in all examined subgroups.
  
  
  CONCLUSIONS
  In this large contemporary cohort of nondialysis-dependent patients with CKD, ACEI/ARB administration was associated with greater survival.
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine Medical Center, Irvine, California; Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine Medical Center, Irvine, California; Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: VA Informatics and Computing Infrastructure, Salt Lake City, Utah.
authors.forename: Evan H
authors.initials: EH
authors.lastname: Lott
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Jun Ling
authors.initials: JL
authors.lastname: Lu
authors.affiliation: Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia; Division of Nephrology, University of Virginia, Charlottesville, Virginia.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Malakauskas
authors.affiliation: Division of Nephrology, University of Virginia, Charlottesville, Virginia.
authors.forename: Jennie Z
authors.initials: JZ
authors.lastname: Ma
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Darryl L
authors.initials: DL
authors.lastname: Quarles
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. Electronic address: csaba.kovesdy@va.gov.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011945:Receptors, Angiotensin / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin
keywords: angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; chronic kidney disease; mortality