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January 1, 2016Kidney & Blood Pressure ResearchOpen Access

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

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Why the study?

Does new use of ACEI compared to ARB reduce all-cause mortality and cardiovascular events in hypertensive patients initiating maintenance dialysis?

Population

4,997 hypertensive, Medicare-Medicaid eligible patients initiating chronic maintenance dialysis between…

Comparison

New use of Angiotensin Converting Enzyme… vs New use of Angiotensin Receptor Blockers (ARB)

Design

Cohort

Key result

New use of ACE inhibitors in patients initiating maintenance dialysis was associated with a higher risk of all-cause mortality compared to ARBs (AHR 1.22; 99% CI 1.05-1.42).

Authors

TSTheresa I. ShiremanJMJonathan D. MahnkenMPMilind A. Phadnis

Discussion

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Overview

ACEI initiation may raise mortality risk versus ARBs in new dialysis patients; leaves open need for RCTs before practice change.

Key Points

  • The aim is to compare the impact of ACE inhibitors versus ARBs on mortality and cardiovascular events in maintenance dialysis patients.
  • Retrospective cohort study of hypertensive, Medicare-Medicaid eligible patients initiating chronic dialysis from 2000 to 2005.
  • Analyzed outcomes of all-cause mortality and cardiovascular hospitalization or death using Cox proportion hazards models.
  • Included 3,555 ACEI users and 1,442 ARB users for mortality, and 3,289 ACEI users and 1,346 ARB users for CV-endpoint.
  • ACEI users showed a higher adjusted hazard ratio for all-cause mortality (AHR = 1.22, 99% CI 1.05-1.42).
  • ACEI users also had a trend towards higher risk for cardiovascular endpoints (AHR = 1.12, 99% CI 0.99-1.27).
  • Patients taking ARBs had a comparatively lower risk for mortality and cardiovascular events.

Study Design

Type

Cohort (n=4,997)

Multicenter

Yes

Structured PICO

Does new use of ACEI compared to ARB reduce all-cause mortality and cardiovascular events in hypertensive patients initiating maintenance dialysis?

P
Population
4,997 hypertensive, Medicare-Medicaid eligible patients initiating chronic dialysis who were new users of either an ACEI or ARB.
E
Exposure
New use of Angiotensin Converting Enzyme Inhibitors (ACEI)
C
Comparator
New use of Angiotensin Receptor Blockers (ARB)
O
Outcome
All-cause mortality (ACM) and combined cardiovascular hospitalization or death (CV-endpoint)hard clinical

Main Result

Hazard Ratio: 1.22 (95% CI 1.05–1.42)

In hypertensive patients initiating maintenance dialysis, new use of ACE inhibitors was associated with a higher risk of all-cause mortality compared to ARBs.

Cite This Study

Shireman et al. (2016) conducted a cohort in Hypertension and maintenance dialysis (n=4,997). Angiotensin converting enzyme inhibitors (ACEI) vs. Angiotensin receptor blockers (ARB) was evaluated on All-cause mortality (AHR 1.22, 95% CI 1.05-1.42). New use of ACE inhibitors in patients initiating maintenance dialysis was associated with a higher risk of all-cause mortality compared to ARBs (AHR 1.22; 99% CI 1.05-1.42).

synapsesocial.com/papers/6a35da5ca4e90ae4d3ef5032https://doi.org/10.1159/000452590
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