Influence of renin–angiotensin system blockades on vascular access survival in patients on maintenance hemodialysis

Abstract

IntroductionResults on the association between the use of renin–angiotensin system blockades (RASBs) and vascular access‐related outcomes are inconsistent. We aimed to compare vascular access‐related outcomes according to the use of RASBs in hemodialysis patients.MethodsThis study used data from a national hemodialysis quality assessment program of the Republic of Korea (n = 54,903). Group 1 was not prescribed any blood pressure‐lowering drugs (n = 28,521). Group 2 was prescribed other blood pressure‐lowering agents except for RASBs (n = 9571). Group 3 was prescribed RASBs (n = 16,811). Vascular access‐related outcomes were classified into intervention‐free survival (IFS), thrombosis‐free survival (TFS), and vascular access survival (VAS).ResultsNo significant difference in the three access survival rates was identified among the three groups. The multivariate Cox regression analyses indicated that Group 3 had better outcomes in IFS and TFS than Group 1. The numbers of angioplasties performed were significantly greater in Group 1 than in the other two groups. The numbers of thrombectomies performed were significantly the lowest in Group 3 among all the groups.ConclusionsOur study revealed different results according to types of access survival in univariate or multivariate analyses. The association of RASBs with favorable outcomes in vascular access remains unclear.