Heart failure, chronic kidney disease, and renin-angiotensin system inhibition

心力衰竭、慢性肾脏疾病和肾素-血管紧张素系统抑制

• 批准号: 7433751
• 负责人: ALI AHMED
• 金额: $ 31.79万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-15 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7433751
• 关键词: Abbreviations; Acute; Admission activity; African American; Age; Aging; Alabama; Aldosterone; American; American Heart Association; Angiotensin II; Angiotensin II Type 1 Receptor Blockers; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Belief; Blood; Cardiology; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Clinical; Clinical Data; Confidence Intervals; Contracts; Creatinine; Data; Data Files; Data Set; Diastolic heart failure; Diet Modification; Digitalis (genus); Digitalis preparation; Disease; Drug usage; EFRAC; Educational process of instructing; Elderly; Enalapril; End stage renal failure; Enrollment; Foundations; Glomerular Filtration Rate; Goals; Guidelines; Heart; Heart failure; Hospitalization; Hospitals; Inpatients; Institutes; Investigation; Kidney; Kidney Diseases; Lead; Left; Left Ventricular Dysfunction; Left Ventricular Ejection Fraction; Life; Long-Term Effects; Lung; Management Information Systems; Medicare; Neurohormones; New York; Observational Study; Odds Ratio; Outcome; Pathogenesis; Patient Care; Patient Representative; Patients; Perception; Pharmaceutical Preparations; Policies; Population; Prevalence; Principal Investigator; Property; Provider; Randomized; Randomized Controlled Trials; Rate; Renin-Angiotensin System; Research; Research Personnel; Risk; Score; Serum; Severities; Source; Specialized Center; Standards of Weights and Measures; Systolic heart failure; Techniques; Time; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Universities; Ventricular Dysfunction; Vital Status; Woman; base; cohort; college; cost; design; evidence based guidelines; hazard; health care quality; improved; mortality; outcome forecast; programs; quality assurance; quality improvement organization; receptor; treatment effect; young adult

DESCRIPTION (provided by applicant): Most heart failure (HF) patients suffer from chronic kidney disease (CKD). HF patients with CKD have one of the poorest prognoses, yet they are also least likely to receive life-saving medications such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB). There have been no randomized controlled trials (RCT) of ACEI/ARB in HF-CKD patients to guide clinical practice, and none are likely to be conducted soon. Moreover, clinicians often perceive ACE/AB-associated rise in serum creatinine as an indication of renal damage. This belief and practice engrained in traditional teaching is unlikely to change without strong evidence of survival benefit of ACEI/ARB in HF-CKD patients. Our specific hypothesis is that ACEI/ARB would reduce mortality and hospitalization in HF patients with CKD. We base our hypothesis on the fact that activation of the renin-angiotensin system (RAS) forms the basis of the pathogenesis and progression of both HF and CKD, suppression of which forms the basis of cardio- and reno-protective properties of ACEI/ARB. Therefore, we postulate that patients with both HF and CKD will benefit from these drugs. Alabama HF Project (AHFP) is a large (8555 patients from 106 hospitals), recent (1998-2001), and rich dataset with -200 well-defined variables including serum creatinine, ejection fraction, and medications. The AHFP cohort closely resembles real-life HF patients in terms of age (mean 77 years) and diversity (>50% women, > 20% non-whites), allowing the assessment of patients often excluded from RCT. In addition, Studies of Left Ventricular Dysfunction (SOLVD) (N=2569; 83 hospitals; mean age 61 years, 20% women, 20% nonwhite) data will be use to study the effect of ACEI of ambulatory systolic HF patients with CKD. The specific aims of this study are to determine the effects of ACEI/ARB on mortality and hospitalization in systolic and diastolic HF patients with CKD, and the effect of ARB (versus ACEI) on mortality and hospitalization in HF-CKD patients using propensity score technique. Our long-term goal is to produce strong evidence, based on a rigorously designed and conducted non- randomized study, which will challenge existing clinical practice of nonuse/underuse of ACEI/ARB in HF- CKD patients, and improve quality and outcomes of HF care.

描述（由申请人提供）：大多数心力衰竭（HF）患者患有慢性肾脏疾病（CKD）。 HF患者患有CKD最糟糕的预后之一，但是他们也不太可能接受挽救生命的药物，例如血管紧张素转化酶抑制剂或血管紧张素受体阻滞剂（ACEI/ARB）。在HF-CKD患者中，没有进行ACEI/ARB的随机对照试验（RCT）来指导临床实践，并且很快就不可能进行。此外，临床医生经常将ACE/AB相关的血清肌酐升高视为肾脏损害的指示。这种基于传统教学的信念和实践不太可能改变，而没有强有力的ACEI/ARB在HF-CKD患者中生存益处的证据。我们的具体假设是，ACEI/ARB会降低HF患者的死亡率和住院。我们基于以下事实，即肾素 - 血管紧张素系统（RAS）构成了HF和CKD的发病机理和进展的基础，而HF和CKD的抑制构成了ACEI/ARB的心脏和肾脏保护特性的基础。因此，我们假设患有HF和CKD的患者将从这些药物中受益。阿拉巴马州HF项目（AHFP）是一名大型（来自106家医院的8555名患者），最近（1998-2001）和丰富的数据集，具有-200定义明确的变量，包括血清肌酐，射血分数和药物。 AHFP队列在年龄（平均77岁）和多样性（> 50％的女性，> 20％的非白人）方面与现实生活中的HF患者非常相似，从而可以评估经常排除在RCT之外的患者。此外，对左心室功能障碍（SOLVD）的研究（n = 2569; 83个医院；平均61岁，20％的女性，20％的非白人）数据将用于研究ABSURATION收缩期HF HF患者ACEI的影响。这项研究的具体目的是确定ACEI/ARB对CKD收缩和舒张期HF患者死亡率和住院的影响，以及使用强度分数技术的ARB（与ACEI）对HF-CKD患者的死亡率和住院的影响。我们的长期目标是基于一项严格设计和进行的非随机研究提供强有力的证据，这将挑战HF-CKD患者ACEI/ARB的不使用/不使用的现有临床实践，并提高HF护理的质量和结果。