RAAS inhibitor use was associated with a significantly reduced risk of end-stage renal disease (HR 0.45; 95% CI 0.25-0.82; p=0.009) in patients with MHT-associated TMA.
Cohort (n=170)
Does RAAS inhibitor use reduce the risk of progression to end-stage renal disease in patients with malignant hypertension-associated renal thrombotic microangiopathy?
In patients with malignant hypertension-associated renal thrombotic microangiopathy, RAAS inhibitor use is associated with a reduced risk of progression to end-stage renal disease.
Hazard Ratio: 0.45 (95% CI 0.25–0.82)
p-value: p=0.009
This observational cohort study aimed to identify factors influencing long-term renal outcomes in 170 patients with biopsy-proven malignant hypertension (MHT)–associated renal thrombotic microangiopathy (TMA) who were dialysis-independent at baseline, recruited between 2008 and 2023. Over a median follow-up of 23.5 months, 52 patients (30.6%) progressed to end-stage renal disease (ESRD). Those developing ESRD exhibited significantly higher total cholesterol levels, heavier proteinuria, a greater proportion of global glomerulosclerosis, more advanced interstitial fibrosis/tubular atrophy, and lower baseline eGFR, along with lower use of renin-angiotensin-aldosterone system (RAAS) inhibitors. In Cox regression analysis, elevated total cholesterol (HR = 1.48 per 1 mmol/L change; 95% CI: 1.24–1.77, p < 0.001) and a higher percentage of glomerulosclerosis (HR = 1.24, 95% CI: 1.15–1.33, p < 0.001; per 5% increase of glomerulosclerosis) were independent risk factors for ESRD, while RAAS inhibitor use was associated with a significantly reduced risk (HR = 0.45, 95% CI: 0.25–0.82, p = 0.009). These findings underscore the prognostic value of lipid profiles and histologic injury severity in MHT-associated TMA and support the protective role of RAAS blockade in preserving renal function, which may guide risk stratification and therapeutic decisions in this high-risk population.
Li et al. (Sun,) conducted a cohort in Malignant hypertension-associated renal thrombotic microangiopathy (n=170). RAAS inhibitor use vs. No RAAS inhibitor use was evaluated on End-stage renal disease (ESRD) (HR 0.45, 95% CI 0.25-0.82, p=0.009). RAAS inhibitor use was associated with a significantly reduced risk of end-stage renal disease (HR 0.45; 95% CI 0.25-0.82; p=0.009) in patients with MHT-associated TMA.