Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the international scleroderma renal crisis survey

Marie Hudson, Murray Baron, Solène Tatibouet, Daniel E. Furst, Dinesh Khanna, Laura Hummers, Eric Hachulla, Thomas Medsger, Virginia Steen, Firas Alkassab, Sindhu Johnson, Oyvind Midtvedt, Gabriella Szucs, Elena Schiopu, Patricia E. Carreira, Chris T. Derk, Oliver Distler, Murat Inanc, Nader Khalidi, Tafazzul H. Mahmud & 38 others Maureen D. Mayes, Kevin McKown, Susanna Proudman, Lidia Rudnicka, Stuart Seigel, Jack Stein, Gabriele Valentini, Sule Yavuz, Hector Arbillaga, Beth Hazel, Jan Schulz, Milton Baker, Mike Becker, Jean Cabane, Andrew Chow, Romy Christmann, Philip Clements, Mary Ellen Csuka, Katharina Hanke, Ina Kötter, Soren Jacobsen, Jason Kur, Edward V. Lally, Sophie Ligier, Shikha Mittoo, Christine Peschken, Paloma Garcia De La Pena-Lefebvre, Viviane Queyrel, Richard Silver, Robert Simms, Klaus Sondergaard, Yves Troyanov, Maria C. Turi, John Varga, Panayiotis G. Vlachoyiannopoulos, Alexandre E. Voskuyl, Carol Yeadon, Rene Westhovens

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether exposure to angiotensin-converting enzyme (ACE) inhibitors prior to the onset of scleroderma renal crisis (SRC) leads to worse outcomes of SRC. Methods: Prospective cohort study of incident SRC subjects. The exposure of interest was ACE inhibitors prior to the onset of SRC. The outcomes of interest were death or dialysis during the first year after the onset of SRC. Results: A total of 87 subjects with incident SRC were identified and 1-year follow-up data were obtained in 75 (86%) subjects. Overall, 27 (36%) subjects died within the first year and an additional 19 (25%) remained on dialysis 1 year after the onset of SRC. In adjusted analyses, exposure to ACE inhibitors prior to the onset of SRC was associated with an increased risk of death (hazard ratio 2.42, 95% CI 1.02, 5.75, p <0.05 in the primary analysis and 2.17, 95% CI 0.88, 5.33, p = 0.09 after post-hoc adjustment for pre-existing hypertension). Conclusion: Overall, the 1-year outcomes of SRC were poor. Prior exposure to ACE inhibitors was associated with an increased risk of death after the onset of SRC, although there was uncertainty around the magnitude of the risk and the possibility of residual confounding could not be ruled out. Further studies will be needed to confirm these findings.

Original languageEnglish (US)
Pages (from-to)666-672
Number of pages7
JournalSeminars in Arthritis and Rheumatism
Volume43
Issue number5
DOIs
StatePublished - 2014

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Angiotensin-Converting Enzyme Inhibitors
Kidney
Dialysis
Surveys and Questionnaires
Prehypertension
Uncertainty
Cohort Studies
Prospective Studies

Keywords

  • ACE inhibitors
  • Scleroderma
  • Scleroderma renal crisis

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the international scleroderma renal crisis survey. / Hudson, Marie; Baron, Murray; Tatibouet, Solène; Furst, Daniel E.; Khanna, Dinesh; Hummers, Laura; Hachulla, Eric; Medsger, Thomas; Steen, Virginia; Alkassab, Firas; Johnson, Sindhu; Midtvedt, Oyvind; Szucs, Gabriella; Schiopu, Elena; Carreira, Patricia E.; Derk, Chris T.; Distler, Oliver; Inanc, Murat; Khalidi, Nader; Mahmud, Tafazzul H.; Mayes, Maureen D.; McKown, Kevin; Proudman, Susanna; Rudnicka, Lidia; Seigel, Stuart; Stein, Jack; Valentini, Gabriele; Yavuz, Sule; Arbillaga, Hector; Hazel, Beth; Schulz, Jan; Baker, Milton; Becker, Mike; Cabane, Jean; Chow, Andrew; Christmann, Romy; Clements, Philip; Csuka, Mary Ellen; Hanke, Katharina; Kötter, Ina; Jacobsen, Soren; Kur, Jason; Lally, Edward V.; Ligier, Sophie; Mittoo, Shikha; Peschken, Christine; De La Pena-Lefebvre, Paloma Garcia; Queyrel, Viviane; Silver, Richard; Simms, Robert; Sondergaard, Klaus; Troyanov, Yves; Turi, Maria C.; Varga, John; Vlachoyiannopoulos, Panayiotis G.; Voskuyl, Alexandre E.; Yeadon, Carol; Westhovens, Rene.

In: Seminars in Arthritis and Rheumatism, Vol. 43, No. 5, 2014, p. 666-672.

Research output: Contribution to journalArticle

Hudson, M, Baron, M, Tatibouet, S, Furst, DE, Khanna, D, Hummers, L, Hachulla, E, Medsger, T, Steen, V, Alkassab, F, Johnson, S, Midtvedt, O, Szucs, G, Schiopu, E, Carreira, PE, Derk, CT, Distler, O, Inanc, M, Khalidi, N, Mahmud, TH, Mayes, MD, McKown, K, Proudman, S, Rudnicka, L, Seigel, S, Stein, J, Valentini, G, Yavuz, S, Arbillaga, H, Hazel, B, Schulz, J, Baker, M, Becker, M, Cabane, J, Chow, A, Christmann, R, Clements, P, Csuka, ME, Hanke, K, Kötter, I, Jacobsen, S, Kur, J, Lally, EV, Ligier, S, Mittoo, S, Peschken, C, De La Pena-Lefebvre, PG, Queyrel, V, Silver, R, Simms, R, Sondergaard, K, Troyanov, Y, Turi, MC, Varga, J, Vlachoyiannopoulos, PG, Voskuyl, AE, Yeadon, C & Westhovens, R 2014, 'Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the international scleroderma renal crisis survey', Seminars in Arthritis and Rheumatism, vol. 43, no. 5, pp. 666-672. https://doi.org/10.1016/j.semarthrit.2013.09.008
Hudson, Marie ; Baron, Murray ; Tatibouet, Solène ; Furst, Daniel E. ; Khanna, Dinesh ; Hummers, Laura ; Hachulla, Eric ; Medsger, Thomas ; Steen, Virginia ; Alkassab, Firas ; Johnson, Sindhu ; Midtvedt, Oyvind ; Szucs, Gabriella ; Schiopu, Elena ; Carreira, Patricia E. ; Derk, Chris T. ; Distler, Oliver ; Inanc, Murat ; Khalidi, Nader ; Mahmud, Tafazzul H. ; Mayes, Maureen D. ; McKown, Kevin ; Proudman, Susanna ; Rudnicka, Lidia ; Seigel, Stuart ; Stein, Jack ; Valentini, Gabriele ; Yavuz, Sule ; Arbillaga, Hector ; Hazel, Beth ; Schulz, Jan ; Baker, Milton ; Becker, Mike ; Cabane, Jean ; Chow, Andrew ; Christmann, Romy ; Clements, Philip ; Csuka, Mary Ellen ; Hanke, Katharina ; Kötter, Ina ; Jacobsen, Soren ; Kur, Jason ; Lally, Edward V. ; Ligier, Sophie ; Mittoo, Shikha ; Peschken, Christine ; De La Pena-Lefebvre, Paloma Garcia ; Queyrel, Viviane ; Silver, Richard ; Simms, Robert ; Sondergaard, Klaus ; Troyanov, Yves ; Turi, Maria C. ; Varga, John ; Vlachoyiannopoulos, Panayiotis G. ; Voskuyl, Alexandre E. ; Yeadon, Carol ; Westhovens, Rene. / Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the international scleroderma renal crisis survey. In: Seminars in Arthritis and Rheumatism. 2014 ; Vol. 43, No. 5. pp. 666-672.
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abstract = "Objective: To determine whether exposure to angiotensin-converting enzyme (ACE) inhibitors prior to the onset of scleroderma renal crisis (SRC) leads to worse outcomes of SRC. Methods: Prospective cohort study of incident SRC subjects. The exposure of interest was ACE inhibitors prior to the onset of SRC. The outcomes of interest were death or dialysis during the first year after the onset of SRC. Results: A total of 87 subjects with incident SRC were identified and 1-year follow-up data were obtained in 75 (86{\%}) subjects. Overall, 27 (36{\%}) subjects died within the first year and an additional 19 (25{\%}) remained on dialysis 1 year after the onset of SRC. In adjusted analyses, exposure to ACE inhibitors prior to the onset of SRC was associated with an increased risk of death (hazard ratio 2.42, 95{\%} CI 1.02, 5.75, p <0.05 in the primary analysis and 2.17, 95{\%} CI 0.88, 5.33, p = 0.09 after post-hoc adjustment for pre-existing hypertension). Conclusion: Overall, the 1-year outcomes of SRC were poor. Prior exposure to ACE inhibitors was associated with an increased risk of death after the onset of SRC, although there was uncertainty around the magnitude of the risk and the possibility of residual confounding could not be ruled out. Further studies will be needed to confirm these findings.",
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T1 - Exposure to ACE inhibitors prior to the onset of scleroderma renal crisis-results from the international scleroderma renal crisis survey

AU - Hudson, Marie

AU - Baron, Murray

AU - Tatibouet, Solène

AU - Furst, Daniel E.

AU - Khanna, Dinesh

AU - Hummers, Laura

AU - Hachulla, Eric

AU - Medsger, Thomas

AU - Steen, Virginia

AU - Alkassab, Firas

AU - Johnson, Sindhu

AU - Midtvedt, Oyvind

AU - Szucs, Gabriella

AU - Schiopu, Elena

AU - Carreira, Patricia E.

AU - Derk, Chris T.

AU - Distler, Oliver

AU - Inanc, Murat

AU - Khalidi, Nader

AU - Mahmud, Tafazzul H.

AU - Mayes, Maureen D.

AU - McKown, Kevin

AU - Proudman, Susanna

AU - Rudnicka, Lidia

AU - Seigel, Stuart

AU - Stein, Jack

AU - Valentini, Gabriele

AU - Yavuz, Sule

AU - Arbillaga, Hector

AU - Hazel, Beth

AU - Schulz, Jan

AU - Baker, Milton

AU - Becker, Mike

AU - Cabane, Jean

AU - Chow, Andrew

AU - Christmann, Romy

AU - Clements, Philip

AU - Csuka, Mary Ellen

AU - Hanke, Katharina

AU - Kötter, Ina

AU - Jacobsen, Soren

AU - Kur, Jason

AU - Lally, Edward V.

AU - Ligier, Sophie

AU - Mittoo, Shikha

AU - Peschken, Christine

AU - De La Pena-Lefebvre, Paloma Garcia

AU - Queyrel, Viviane

AU - Silver, Richard

AU - Simms, Robert

AU - Sondergaard, Klaus

AU - Troyanov, Yves

AU - Turi, Maria C.

AU - Varga, John

AU - Vlachoyiannopoulos, Panayiotis G.

AU - Voskuyl, Alexandre E.

AU - Yeadon, Carol

AU - Westhovens, Rene

PY - 2014

Y1 - 2014

N2 - Objective: To determine whether exposure to angiotensin-converting enzyme (ACE) inhibitors prior to the onset of scleroderma renal crisis (SRC) leads to worse outcomes of SRC. Methods: Prospective cohort study of incident SRC subjects. The exposure of interest was ACE inhibitors prior to the onset of SRC. The outcomes of interest were death or dialysis during the first year after the onset of SRC. Results: A total of 87 subjects with incident SRC were identified and 1-year follow-up data were obtained in 75 (86%) subjects. Overall, 27 (36%) subjects died within the first year and an additional 19 (25%) remained on dialysis 1 year after the onset of SRC. In adjusted analyses, exposure to ACE inhibitors prior to the onset of SRC was associated with an increased risk of death (hazard ratio 2.42, 95% CI 1.02, 5.75, p <0.05 in the primary analysis and 2.17, 95% CI 0.88, 5.33, p = 0.09 after post-hoc adjustment for pre-existing hypertension). Conclusion: Overall, the 1-year outcomes of SRC were poor. Prior exposure to ACE inhibitors was associated with an increased risk of death after the onset of SRC, although there was uncertainty around the magnitude of the risk and the possibility of residual confounding could not be ruled out. Further studies will be needed to confirm these findings.

AB - Objective: To determine whether exposure to angiotensin-converting enzyme (ACE) inhibitors prior to the onset of scleroderma renal crisis (SRC) leads to worse outcomes of SRC. Methods: Prospective cohort study of incident SRC subjects. The exposure of interest was ACE inhibitors prior to the onset of SRC. The outcomes of interest were death or dialysis during the first year after the onset of SRC. Results: A total of 87 subjects with incident SRC were identified and 1-year follow-up data were obtained in 75 (86%) subjects. Overall, 27 (36%) subjects died within the first year and an additional 19 (25%) remained on dialysis 1 year after the onset of SRC. In adjusted analyses, exposure to ACE inhibitors prior to the onset of SRC was associated with an increased risk of death (hazard ratio 2.42, 95% CI 1.02, 5.75, p <0.05 in the primary analysis and 2.17, 95% CI 0.88, 5.33, p = 0.09 after post-hoc adjustment for pre-existing hypertension). Conclusion: Overall, the 1-year outcomes of SRC were poor. Prior exposure to ACE inhibitors was associated with an increased risk of death after the onset of SRC, although there was uncertainty around the magnitude of the risk and the possibility of residual confounding could not be ruled out. Further studies will be needed to confirm these findings.

KW - ACE inhibitors

KW - Scleroderma

KW - Scleroderma renal crisis

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