Why the study?
Do ACEIs or ARBs reduce mortality and cardiovascular events in patients with ESRD on hemodialysis?
Population
Patients with end-stage renal disease on hemodialysis, identified from the National Health Insurance…
Comparison
Angiotensin-converting enzyme inhibitors or… vs Nonusers of ACEIs/ARBs.
Design
Cohort
Follow-up
10 years
Key result
Adherent use of ACEIs/ARBs in patients with end-stage renal disease on hemodialysis did not significantly reduce all-cause mortality (HR 0.98) but was associated with increased risks of cardiovascular events compared to nonusers.
Authors
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ACEI/ARB use warrants caution in hemodialysis patients; leaves open whether randomized trials would confirm lack of mortality benefit or increased events.
Cohort (n=15,432)
Do ACEIs or ARBs reduce mortality and cardiovascular events in patients with ESRD on hemodialysis?
Hazard Ratio: 0.98 (95% CI 0.86–1.13)
Absolute Event Rate: 30.8% vs 37.2%
p-value: p=0.801
In patients on hemodialysis, the use of ACEIs or ARBs does not appear to confer the expected cardiovascular and mortality benefits and may be associated with increased cardiovascular events.
Liao et al. (2017) conducted a cohort in End-stage renal disease on hemodialysis (n=15,432). Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin type 1 receptor blockers (ARBs) vs. Nonusers was evaluated on All-cause mortality (HR 0.98, 95% CI 0.86-1.13, p=0.801). Adherent use of ACEIs/ARBs in patients with end-stage renal disease on hemodialysis did not significantly reduce all-cause mortality (HR 0.98) but was associated with increased risks of cardiovascular events compared to nonusers.