Effects of cilostazol and renin-angiotensin system (RAS) blockers on the renal disease progression of Korean patients: a retrospective cohort study
- 170 Downloads
Background Decline in estimated glomerular filtration rate (eGFR) is an important surrogate marker for the assessment of renal function. Addition of a second agent to angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) treatment may improve current therapeutic strategies aimed at suppressing renal disease progression. Objective To determine the effect of cilostazol in combination with ACEI or ARB treatment on the decline in eGFR. Setting A tertiary hospital in Korea. Method In an observational cohort study, we analyzed 5505 patients who were prescribed ACEI or ARB and cilostazol or other antiplatelet agents. Main outcome measure The primary outcome assessed was worsening of renal function defined as a 30% decline in eGFR per year. The secondary outcomes included commencement of dialysis, renal transplantation, death, myocardial infarction, and ischemic stroke. Results Following propensity score matching, eGFR decreased over time in the majority of patients, but the decline was less in patients in the cilostazol treated (CT) group of stage 1–2 category compared to the cilostazol untreated (CU) group (OR 0.80; 95% CI 0.66–0.98). In the subgroup analysis, the strongest effect in slowing eGFR decline was observed in CT patients at a high risk of diabetes (OR 0.782; 95% CI 0.615–0.993) and the elderly (OR 0.693; 95% CI 0.504–0.953) in the stage 1–2 category. No significant increase in cardiovascular risk was observed between the CT and CU groups. Conclusion Treatment with cilostazol plus ACEI or ARB was observed to prevent worsening of renal progression in patients in the stages 1–2.
KeywordsAngiotensin receptor blocker Angiotensin-converting-enzyme inhibitors Chronic kidney disease Cilostazol Glomerular filtration rate (GFR) Renal disease progression South Korea
This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Ministry of Science, ICT & Future Planning, Republic of Korea (No. 2013M3A9B5075838).
Conflicts of interest
The authors declare that they have no conflicts of interest.
- 9.Egido J, Fernandez-Fernandez B, Ortiz A, Mas S, Gómez-Guerrero C. Standard and novel therapeutic approaches to diabetic nephropathy. Port J Nephrol Hypertens. 2015;29(2):101–7.Google Scholar
- 11.Zou Y, Hu C, Ye W, Fan L, Xu L, Zhang A, et al. Long-term clinical efficacy and safety of adding cilostazol to dual antiplatelet therapy after drug-eluting stent implantation in coronary arteries: a meta-analysis of randomized controlled trials. Thromb Res. 2015;136(5):870–7.CrossRefPubMedGoogle Scholar
- 15.International K. Is a decline in estimated GFR an appropriate surrogate end point for renoprotection drug trials? Int Soc Nephrol. 2014;85:723–7.Google Scholar
- 17.Cartet-Farnier E, Goutelle-Audibert L, Maire P, De la Gastine B, Goutelle S. Implications of using the MDRD or CKD-EPI equation instead of the Cockcroft-Gault equation for estimating renal function and drug dosage adjustment in elderly patients. Fundam Clin Pharmacol. 2017;31(1):110–9.CrossRefPubMedGoogle Scholar
- 18.International K. Is a decline in estimated GFR an appropriate surrogate end point for renoprotection drug trials? Int Soc Nephrol. 2014;85:723–7.Google Scholar
- 20.KDIGO. clinical practice guideline for the evaluation and management of chronic kidney diseas. Kidney Int Suppl. 2012;2013(3):136–50.Google Scholar
- 26.Earlier endpoints proposed for chronic kidney disease trials. Nephrol News. 2012. https://www.kidney.org/news/newsroom/nr/Earlier-Endpoints-Proposed-for-Clinical-Trials-in-CKD. Accessed 30 July 2017.
- 32.Service NHI. Koean diabetes fact sheet. Seoul: Korean Diabetes Association; 2015.Google Scholar
- 33.Palmer SC, Di Micco L, Razavian M, Craig JC, Perkovic V, Pellegrini F, et al. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev. 2013;2:CD008834.Google Scholar