title: Renin-Angiotensin-Aldosterone System Blockers in Elderly Adults with Chronic Kidney Disease without Diabetes Mellitus or Proteinuria.
abstract: OBJECTIVE
  To compare the effect of renin-angiotensin-aldosterone system (RAAS) blockers with that of other antihypertensive agents on outcomes in a cohort of elderly veterans with incident chronic kidney disease (CKD) without diabetes mellitus or proteinuria.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Veterans Affairs (VA) Upstate New York Healthcare System.
  
  
  METHODS
  All participants were seen in primary care clinic in Veterans Integrated Service Network 2, which comprises five VA medical centers and 29 community-based outpatient clinics, from April 2001 to April 2008. Veterans with incident CKD who were taking antihypertensive medications and did not have proteinuria or diabetes mellitus on the date of onset of CKD were selected from this population.
  
  
  METHODS
  The outcome variables studied were progression of kidney disease (doubling of serum creatinine level or Stage 5 CKD (estimated glomerular filtration rate <15 mL/min per 1.73 m2)), all-cause mortality, and combined outcome.
  
  
  RESULTS
  Analysis included 2,474 participants, 47.9% of whom were taking RAAS blockers at baseline and the rest other antihypertensives. Time-varying Cox proportional hazards analyses did not reveal a statistically significant difference in primary combined outcome in participants taking RAAS blockers and those taking other antihypertensives (hazard ratio = 1.09, 95% confidence interval = 0.93-1.27). There was also no significant effect on individual outcomes (death or progression of kidney disease).
  
  
  CONCLUSIONS
  Use of RAAS blockers was not associated with less hazard of combined and individual outcomes (doubling of serum creatinine, Stage 5 CKD, death) in elderly veterans with incident CKD without diabetes mellitus or proteinuria.
authors.affiliation: Department of Medicine, University at Buffalo, Buffalo, New York.|Department of Biostatistics, University at Buffalo, Buffalo, New York.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Arora
authors.affiliation: Division of Nephrology, Veterans Affairs Medical Center, Buffalo, New York.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Golzy
authors.affiliation: Department of Medicine, Virginia Commonwealth University, Richmond, Virginia.|Division of Nephrology, Veterans Affairs Medical Center, Richmond, Virginia.
authors.forename: Nilang
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Quigg
authors.affiliation: Division of Nephrology, Veterans Affairs Medical Center, Buffalo, New York.
authors.forename: Randolph L
authors.initials: RL
authors.lastname: Carter
authors.affiliation: Department of Medicine, University at Buffalo, Buffalo, New York.|Department of Biostatistics, University at Buffalo, Buffalo, New York.
authors.forename: James W
authors.initials: JW
authors.lastname: Lohr
keywords: chronic kidney disease; elderly; renin-angiotensin-aldosterone system blockers