Comparative Effectiveness of Renin-Angiotensin System Antagonists in Maintenance Dialysis Patients

Shireman, Theresa I.; Mahnken, Jonathan D.; Phadnis, Milind A.; Ellerbeck, Edward F.; Wetmore, James B.

doi:10.1159/000452590

Cited by 6 publications

(3 citation statements)

References 58 publications

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“…We excluded patients younger than 20 years old at the first prescription date, those who had more than 12 dialysis treatments within 180 days before the first prescription date, or who had received a catastrophic illness certificate for CKD with long-term dialysis before the first prescription date [16, 17]. We also excluded the renal transplant recipients (ICD-9-CM: 55.6, V42.0; procedure code: 76020B) at any time before the first prescription date.…”

Section: Methodsmentioning

confidence: 99%

Renoprotective Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Diabetic Patients with Proteinuria

Hsu¹,

Lin²,

Ou³

et al. 2017

Kidney Blood Press Res

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Background/Aims: Limited evidence exists on the choice of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in diabetic patients with nephropathy. We aim to assess the renal effectiveness and safety of these drugs among diabetic nephropathy patients. Methods: This retrospective cohort study was conducted with diabetic nephropathy patients who initiated ACEI or ARB monotherapy. The primary outcome was a composite of end stage of renal disease and renal transplantation, and the secondary outcome was all-cause mortality. The safety endpoint was hyperkalemia. Results: Three thousand seven hundred and thirty-nine ACEI users and 3,316 ARB users were identified. ARBs seemed to be inferior to ACEIs given their poorer renal outcome (HR 1.31; 95% CI, 1.15-1.50) and higher risk of hyperkalemia (HR 1.17; 95% CI, 1.04-1.32). Among the four ACEIs compared, captopril was an inferior treatment choice given its poorer renal outcomes (HR 1.42; 95% CI, 1.05-1.93) and higher mortality rate (HR 1.25; 95% CI, 1.01-1.55). Irbesartan appeared to be a poorer treatment choice among the three ARBs compared, given its inferior renal protective effect (HR 1.35; 95% CI, 1.03-1.78). Conclusions: Our findings suggest ACEIs as a relatively more renoprotective and safer treatment as compared to ARBs. Captopril and irbesartan may be inferior to the other ACEIs and ARBs respectively.

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Section: Methodsmentioning

confidence: 99%

Renoprotective Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Diabetic Patients with Proteinuria

Hsu¹,

Lin²,

Ou³

et al. 2017

Kidney Blood Press Res

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“…Shireman et al. included 4997 patients undergoing dialysis (3555 ACEI and 1442 ARB users) and compared all-cause mortality and cardiovascular events [ 15 ]. In their study, ACEI use was associated with greater all-cause mortality and a trend toward an increased risk of cardiovascular events than ARB use.…”

Section: Discussionmentioning

confidence: 99%

Effect of angiotensin-converting enzyme inhibitors versus that of angiotensin receptor blockers on survival in patients undergoing hemodialysis: a nationwide observational cohort study

Kang,

Kim,

Kim

et al. 2024

Renal Failure

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Background This study aimed to evaluate the patient survival rates based on the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in a large cohort of patients undergoing maintenance hemodialysis (HD). Methods Data from a national HD quality assessment program were used in this retrospective study. The patients were classified into four groups based on the use of renin-angiotensin system blockers (RASBs) as follows: No group, patients without a prescription of any anti-hypertensive drugs including RASBs; Other group, patients with a prescription of anti-hypertensive drugs excluding RASBs; ACEI group, patients with a prescription of an ACEI; and ARB group, patients with a prescription of an ARB. Results The 5-year survival rates in the no, other, ACEI, and ARB groups were 68.6%, 67.8%, 70.6%, and 69.2%, respectively. The ACEI group had the best patient survival trend among the four groups. In multivariable Cox regression analyses, no differences were observed between the ACEI and ARB groups. Among young patients and patients without diabetes or heart disease, the ACEI group had the best patient survival among the four groups. However, among patients with DM or heart disease, the ARB group had the best patient survival. Conclusions Our study found that patients receiving ACEI and ARB had comparable survival. However, patients receiving ARB had better survival in the subgroups of patients with DM or heart disease, and patients receiving ACEI had better survival in the subgroup of young patients or patients without diabetes or heart disease.

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“…Combination of ACEI and ARB increases the mortality of hemodialysis patients [33][34][35]. However, some studies have found that ARB drugs cannot reduce the risk of cardiovascular events and total mortality in long-term dialysis patients compared with other antihypertensive drugs [36][37].…”

Section: Discussionmentioning

confidence: 99%

Risk factors and antihypertensive medications for mortality in elderly hospitalized hemodialysis patients: a multicenter retrospective study in China

Song¹,

Cai²,

Xiao³

et al. 2019

Preprint

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Background Elderly Hemodialysis patients are increasing yearly. Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity andmortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes and analyze the risk factors in elderly hemodialysis patients.Methods This study was a retrospective cohort study based on data from adult hemodialysis patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of elderly hemodialysis patients (≥60 years old) were analyzed. Antihypertensive drugs into the following regimens: β-blockers, calcium channel blockers, renin–angiotensin system (RAS) blocking drugs and α-blockers. Logistic regression analysis was used to explore the risk factors for death adjusting for clinical and laboratory values and antihypertensive medications.Results A total of 7135 patients on maintenance hemodialysis including 2738 elderly patients were enrolled in this study. The mean levels of hemoglobin, albumin, blood calcium, phosphorus and parathyroid hormone (PTH) in elderly group were lower than the younger group. We compared the characteristics of 2492 survived elderly maintenance hemodialysis patients and 246 patients who died.Aging (OR = 1.59, 95% CI: 1.13-2.24), central venous catheter (OR = 1.62, 95% CI: 1.53-1.72) and Charlson comorbidities index>3(OR=1.97,95% CI: 1.49-2.60)were independently risk factors of mortality in elderly maintenance hemodialysis patients. High levels of hemoglobin (OR=0.76, 95%CI: 0.73-0.79), albumin (OR=0.87, 95%CI: 0.77-0.98), uric acid(OR=0.90,95%CI: 0.84-0.96)and those taking angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) (OR=0.77, 95%CI: 0.58-0.90) had a lower risk of mortality.Conclusions Age, Charlson Comorbidities index >3, anemia and malnutrition, the use of central venous catheters and low serum uric acid level are risk factors for mortality in elderly maintenance hemodialysis patients. Taking ACEI/ARB can reduce the mortality of elderly maintenance hemodialysis patients.

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Comparative Effectiveness of Renin-Angiotensin System Antagonists in Maintenance Dialysis Patients

Cited by 6 publications

References 58 publications

Renoprotective Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Diabetic Patients with Proteinuria

Renoprotective Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Diabetic Patients with Proteinuria

Effect of angiotensin-converting enzyme inhibitors versus that of angiotensin receptor blockers on survival in patients undergoing hemodialysis: a nationwide observational cohort study

Risk factors and antihypertensive medications for mortality in elderly hospitalized hemodialysis patients: a multicenter retrospective study in China

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