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Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: cohort study

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j791 (Published 09 March 2017) Cite this as: BMJ 2017;356:j791

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This bellow is In the bellow summary of results in this paper: Where is the stratification about this population ethinicity?

R:Trere are no meaningfull amountof Blacks and Asian ethinicities treated by ACE-Is or ARBs in the primary health care in thr UK? Ysed nephrotoxicity? If yes there ethnicities are part of this sick population why they were not mentioned, numbered, and analysed in this cohort? Meanwhile it is common place that at least black people in a number of clinical trials and large observational studies receive higher ACE-Is or ARBs because of lower efficacy (1)which would well turnr into increa
Main outcome measures Poisson regression was used to compare rates of end stage renal disease, myocardial infarction, heart failure, and death among patients with creatinine increases of 30% or more after starting treatment against those without such increases, and for each 10% increase in creatinine. Analyses were adjusted for age, sex, calendar period, socioeconomic status, lifestyle factors, chronic kidney disease, diabetes, cardiovascular comorbidities, and use of other antihypertensive drugs and non-steroidal anti-inflammatory drugs.
Results Among the 2078 (1.7%) patients with creatinine increases of 30% or more, a higher proportion were female, were elderly, had cardiorenal comorbidity, and used non-steroidal anti-inflammatory drugs, loop diuretics, or potassium sparing diuretics. Creatinine increases of 30% or more were associated with an increased adjusted incidence rate ratio for all outcomes, compared with increases of less than 30%: 3.43 (95% confidence interval 2.40 to 4.91) for end stage renal disease, 1.46 (1.16 to 1.84) for myocardial infarction, 1.37 (1.14 to 1.65) for heart failure, and 1.84 (1.65 to 2.05) for death. The detailed categorisation of increases in creatinine concentrations (<10%, 10-19%, 20-29%, 30-39%, and ≥40%) showed a graduated relation for all outcomes (all P values for trends <0.001). Notably, creatinine increases of less than 30% were also associated with increased incidence rate ratios for all outcomes, including death (1.15 (1.09 to 1.22) for increases of 10-19% and 1.35 (1.23 to 1.49) for increases of 20-29%, using <10% as reference). Results were consistent across calendar periods, across subgroups of patients, and among continuing users. Analyses were adjusted for age, sex, calendar period, socioeconomic status, lifestyle factors, chronic kidney disease,
diabetes, cardiovascular comorbidities, and use of other antihypertensive drugs and non-steroidal anti-inflammatory drugs.

So, whis this ethnical informations are missing in this paper?

REFERENCES:
Gbenga Ogedegbe, Nirav R. Shah, Christopher Phillips, Keith Goldfeld, Jason Roy, Yu Guo, Joyce Gyamfi, Christopher Torgersen, Louis Capponi, Sripal Bangalore .

file:///C:/Users/JOSE%20MARIO/Downloads/1224.full.pdf

Competing interests: No competing interests

12 April 2017
Jose Mario de Oliveira
Associate Professor of Medicine.
Depe.artment of Medicine. Universidade Federal Fluminens
Rua Senador Vergueiro # 2 Apt. 202.., Flamengo. Rio de Janeiro, RJ, Brazil.