Current guidelines on hypertension treatment in chronic kidney disease (CKD) patients discourage combined angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blocker (ARB) use due to the risk of an increased kidney function decline. However, dual compared to single renin-angiotensin system (RAS) blockade may have more efficacy with regard to hypertension and proteinuria. Among incident predialysis patients (CKD 4-5), we compared dual with no or single RAS blockade regarding kidney function decline and risk of renal replacement therapy (RRT) or death. In a multicenter cohort study, 495 incident predialysis patients (>18 years) were included between 2004 and 2011 and followed until RRT, death, or October 2016. At baseline, patients were divided into four categories: nonuser, single or dual user of ACEi and/or ARB. Cox models were used to estimate the hazard ratio for the combined end point RRT or death. Differences in decline of kidney function among the four drug groups were compared with a linear mixed model. A total of 119 patients were nonusers, 164 ACEi users, 133 ARB users, and 79 dual RAS users. Compared to nonusers, the multivariable adjusted hazard ratio (95% confidence interval) for the combined end point was 0.75 (0.65 to 0.86) for ACEi users, 0.87 (0.76 to 1.00) for ARB users, and 0.79 (0.67 to 0.94) for dual RAS users. The average annual decline in kidney function did not differ among the four groups. We observed in predialysis patients that compared to no RAS blockade, both dual RAS blockade and single ACEi use were associated with about 20%-25% lower risk of RRT or death, without difference in kidney function decline.

中文翻译：

---

肾素-血管紧张素系统双重阻断与非肾脏阻断相比，对透析前患者肾替代治疗或死亡风险的影响：PREPARE-2研究。

由于存在增加的肾功能下降的风险，目前在慢性肾脏病（CKD）患者中进行高血压治疗的现行指南不建议同时使用血管紧张素转换酶抑制剂（ACEi）和血管紧张素II受体阻滞剂（ARB）。但是，与单一肾素-血管紧张素系统（RAS）阻断剂相比，双重阻断剂在高血压和蛋白尿方面可能更具疗效。在透析前事件患者（CKD 4-5）中，我们比较了肾脏功能下降和肾脏替代疗法（RRT）或死亡风险的双重或非双重性RAS阻滞。在一项多中心队列研究中，包括2004年至2011年之间的495名透析前期患者（> 18岁），一直随访到RRT，死亡或2016年10月。在基线时，患者分为四类：非使用者，单人或双重使用者ACEi和/或ARB。使用Cox模型估算联合终点RRT或死亡的危险比。将四个药物组之间肾功能下降的差异与线性混合模型进行了比较。共有119位患者为非用户，164位ACEi用户，133位ARB用户和79位双重RAS用户。与非使用者相比，ACEi使用者的组合终点多变量调整后的危险比（95％置信区间）为0.75（0.65至0.86），ARB使用者为0.87（0.76至1.00），双重使用者为0.79（0.67至0.94） RAS用户。四组之间肾功能的年平均下降没有差异。我们在透析前患者中观察到，与没有RAS阻滞相比，双重RAS阻滞和单次ACEi服用均使RRT或死亡风险降低约20％-25％，而肾功能下降无差异。