Early initiation of angiotensin-converting enzyme inhibitor in patients with scleroderma renal crisis: A nationwide inpatient database study

Tomoaki Ida; Kei Ikeda; Hiroyuki Ohbe; Kaito Nakamura; Hiroki Furuya; Taro Iwamoto; Shunsuke Furuta; Yoshihisa Miyamoto; Mikio Nakajima; Yusuke Sasabuchi; Hiroki Matsui; Hideo Yasunaga; Hiroshi Nakajima

doi:10.1093/rheumatology/kead343

Early initiation of angiotensin-converting enzyme inhibitor in patients with scleroderma renal crisis: A nationwide inpatient database study

Rheumatology (Oxford). 2023 Jul 17:kead343. doi: 10.1093/rheumatology/kead343. Online ahead of print.

Authors

Affiliations

¹ Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
³ Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
⁴ Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
⁵ Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
⁶ Department of Real World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

PMID: 37458488
DOI: 10.1093/rheumatology/kead343

Abstract

Objectives: To evaluate the effectiveness of early initiation of angiotensin-converting enzyme inhibitor (ACEi) in patients with scleroderma renal crisis (SRC).

Methods: This was a retrospective cohort study using a nationwide inpatient database in Japan from July 2010 to March 2020. All hospitalized patients with SRC were divided into those who received ACEi within two days of admission (early ACEi group) and those who did not (control group). Propensity-score overlap weighting analysis was performed to adjust for confounding factors. The primary outcome was the composite of in-hospital mortality or hemodialysis dependence at discharge.

Results: Of the 475 eligible patients, 248 (52.2%) were in the early ACEi group and 227 (47.8%) were in the control group. After overlap weighting, the primary outcome was significantly lower in the early ACEi group than in the control group (40.1% vs. 49.0%; odds ratio, 0.69; 95% confidence interval, 0.48-1.00; P= 0.049).

Conclusions: The present study showed that early initiation of ACEi was associated with lower composite outcome of in-hospital mortality or hemodialysis dependence at discharge in patients with SRC. Further prospective studies are warranted to verify the present findings.

Keywords: angiotensin-converting enzyme inhibitor; scleroderma renal crisis; systemic sclerosis.