Introduction:
To explore the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) treatment and short-term clinical outcome in dialysis patients with hypertension admitted to intensive care unit (ICU).
Methods
Patients with diagnosis of hypertension and dialysis from Medical Information Mart for Intensive Care IV database were included. Based on whether treated with ACEI/ARB, patients were categorized into two groups: ACEI/ARB group and non- ACEI/ARB group. A comparison of in-hospital mortality and 30-day mortality was conducted between the two groups in the entire study population and following propensity score matching (PSM).
Results
The study included 647 hypertensive dialysis patients, among which 227 (34.70%) were treated with ACEI/ARB and 420 (65.30%) were not. Compared to non- ACEI/ARB group, fewer patients in ACEI/ARB group suffered from atrial fibrillation/flutter (17.2% vs 31.9%, p < 0.001). The hospital mortality rate was 5.1% and 9.0% died during 30-day follow-up period in the whole study population. Patients receiving ACEI/ARB were with better clinical outcomes during hospitalization (2.2% vs 6.7%, p = 0.023) and after 30-day follow-up (5.3% vs 11.0%, p = 0.016). ACEI/ARB treatment (HR 0.24, 96% CI: 0.051–0.82, p = 0.038) was independently correlated with a lower risk of hospital mortality. After PSM of 112 pairs, the ACEI/ARB group exhibited superior in-hospital (99.1% vs 91.1%, p = 0.013) and 30-day (95.5% vs 88.4%, p = 0.048) survival rates. Use of ACEI/ARB demonstrated an independent protective factor for 30-day mortality. (HR 0.33, 95% CI: 0.11–0.96, p = 0.041).
Conclusion
ACEI/ARB treatment showed a significant association with improved in-hospital and 30-day clinical outcomes in hypertensive patients receiving dialysis in ICU.