Ryo Kido1,2, Tadao Akizawa3, Masafumi Fukagawa4, Yoshihiro Onishi2, Takuhiro Yamaguchi5, Shunichi Fukuhara6,7. 1. Medical Examination Center, Inagi Municipal Hospital, Tokyo, Japan. 2. Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan. 3. Division of Nephrology, Showa University School of Medicine, Kyoto, Japan. 4. Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan. 5. Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan. 6. Department of Healthcare Epidemiology, School of Public Health, Kyoto University Faculty of Medicine, Kyoto, Japan. 7. Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
Abstract
BACKGROUND: Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. METHODS: We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. RESULTS: Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50-0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57-1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22-5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. CONCLUSION: Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations.
BACKGROUND: Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. METHODS: We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. RESULTS: Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50-0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57-1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22-5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. CONCLUSION: Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations.
Authors: W N Suki; R Zabaneh; J L Cangiano; J Reed; D Fischer; L Garrett; B N Ling; S Chasan-Taber; M A Dillon; A T Blair; S K Burke Journal: Kidney Int Date: 2007-08-29 Impact factor: 10.612
Authors: Brian D Bradbury; M Alan Brookhart; Wolfgang C Winkelmayer; Cathy W Critchlow; Ryan D Kilpatrick; Marshall M Joffe; Harold I Feldman; John F Acquavella; Ouhong Wang; Kenneth J Rothman Journal: Am J Kidney Dis Date: 2009-07-09 Impact factor: 8.860
Authors: Glenn M Chertow; Geoffrey A Block; Ricardo Correa-Rotter; Tilman B Drüeke; Jürgen Floege; William G Goodman; Charles A Herzog; Yumi Kubo; Gerard M London; Kenneth W Mahaffey; T Christian H Mix; Sharon M Moe; Marie-Louise Trotman; David C Wheeler; Patrick S Parfrey Journal: N Engl J Med Date: 2012-11-03 Impact factor: 91.245
Authors: Kevin E Chan; T Alp Ikizler; Jorge L Gamboa; Chang Yu; Raymond M Hakim; Nancy J Brown Journal: Kidney Int Date: 2011-07-20 Impact factor: 10.612
Authors: Antonio Alberto Lopes; Jennifer L Bragg-Gresham; Sylvia P B Ramirez; Vittorio E Andreucci; Takashi Akiba; Akira Saito; Stefan H Jacobson; Bruce M Robinson; Friedrich K Port; Nancy A Mason; Eric W Young Journal: Nephrol Dial Transplant Date: 2009-05-14 Impact factor: 5.992