https://scholars.lib.ntu.edu.tw/handle/123456789/524163
Title: | Effects of angiotensin converting enzyme inhibition or angiotensin receptor blockade in dialysis patients: A nationwide data survey and propensity analysis | Authors: | CHO-KAI WU Yang Y.-H. JYH-MING JIMMY JUANG YI-CHIH WANG CHIA-TI TSAI LING-PING LAI HWANG, JUEY-JEN FU-TIEN CHIANG PAU-CHUNG CHEN JIUNN-LEE LIN LIAN-YU LIN |
Issue Date: | 2015 | Publisher: | Lippincott Williams and Wilkins | Journal Volume: | 94 | Journal Issue: | 3 | Source: | Medicine (United States) | Abstract: | Long-term benefit of using a renin-angiotensin-aldosterone system blocker such as an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) for patients already receiving dialysis remains undetermined. The aim of this study is to assess the efficacy and safety of ACEI or ARB use in dialysis patients. We performed a population-based cohort study with time-to-event analyses to estimate the relation between the use of ACEI/ARB and their outcomes. We used a nationwide database (Registry for Catastrophic Illnesses) for Taiwan, which has data from 1995 to 2008 nearly of all patients who received dialysis therapy. The records of all dialysis patients aged ?18 with no evidence of cardiovascular (CV) events in 1997 and 1998 (133,564 patients) were examined. Users (n=50,961) and nonusers (n=59,913) of an ACEI/ARB were derived. We then used propensity score matching and Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) for all-cause mortality and CV events in users and nonusers of an ACRI/ARB. The 15,182 patients, who used an ACEI/ARB, and the 15,182 nonusers had comparable baseline characteristics during the 14 years of follow-up. The mortality was significantly greater in patients who did not use an ACEI/ARB (HR=0.90, 95% confidence interval=0.86-0.93). Subgroup analysis of 3 tertiles of patients who used different total amounts of ACEI/ARB during the study period indicated that CV events were more common in patients who used an ACEI/ARB for a short duration (tertile 1: HR=1.63), but less common in those who used an ACEI/ARB for long durations (tertile 2: HR=1.05; tertile 3: HR=0.94; trend for declining HR from tertile 1 to 3: P<0.001). The mortality benefit provided by use of an ACEI/ARB was consistent across most patient subgroups, as was the benefit of ARB monotherapy rather than ACEI monotherapy. Independent of traditional risk factors, overall mortality was significantly lower in dialysis patients who used an ACEI/ARB. In addition, subjects who used an ACEI/ARB for longer durations were significantly less likely to experience CV events. ? 2015 Wolters Kluwer Health, Inc. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84922290749&doi=10.1097%2fMD.0000000000000424&partnerID=40&md5=65e8b7e2871ffc56e18c5191c50dc691 https://scholars.lib.ntu.edu.tw/handle/123456789/524163 |
ISSN: | 0025-7974 | DOI: | 10.1097/MD.0000000000000424 | SDG/Keyword: | angiotensin receptor; angiotensin receptor antagonist; antithrombocytic agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase; dipeptidyl carboxypeptidase inhibitor; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; oral antidiabetic agent; warfarin; angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; adult; Article; brain hemorrhage; brain ischemia; cardiovascular disease; cohort analysis; diabetes mellitus; drug efficacy; drug safety; enzyme inhibition; female; follow up; heart atrium fibrillation; hemodialysis; hemodialysis patient; human; hyperlipidemia; hypertension; major clinical study; male; medical record review; monotherapy; mortality; outcome assessment; peripheral occlusive artery disease; peritoneal dialysis; priority journal; receptor blocking; renal replacement therapy; treatment duration; aged; Cardiovascular Diseases; drug combination; health survey; Kidney Failure, Chronic; middle aged; propensity score; renal replacement therapy; retrospective study; survival rate; Taiwan; time; treatment outcome; Adult; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Diseases; Cohort Studies; Drug Therapy, Combination; Female; Follow-Up Studies; Health Surveys; Humans; Kidney Failure, Chronic; Male; Middle Aged; Propensity Score; Renal Dialysis; Retrospective Studies; Survival Rate; Taiwan; Time Factors; Treatment Outcome |
Appears in Collections: | 醫學系 |
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