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. MahmudMaureen 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 - Apr 2014

Keywords

  • ACE inhibitors
  • Scleroderma
  • Scleroderma renal crisis

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

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    Hudson, M., Baron, M., Tatibouet, S., Furst, D. E., Khanna, D., Hummers, L., Hachulla, E., Medsger, T., Steen, V., Alkassab, F., Johnson, S., Midtvedt, O., Szucs, G., Schiopu, E., Carreira, P. E., Derk, C. T., Distler, O., Inanc, M., Khalidi, N., ... 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, 43(5), 666-672. https://doi.org/10.1016/j.semarthrit.2013.09.008