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- Title
Impact of use of angiotensin II receptor blocker on all-cause mortality in hemodialysis patients: prospective cohort study using a propensity-score analysis.
- Authors
Tanaka, Marenao; Yamashita, Tomohisa; Koyama, Masayuki; Moniwa, Norihito; Ohno, Kohei; Mitsumata, Kaneto; Itoh, Takahito; Furuhashi, Masato; Ohnishi, Hirofumi; Yoshida, Hideaki; Tsuchihashi, Kazufumi; Miura, Tetsuji
- Abstract
Background: It is controversial whether treatment with an angiotensin II receptor blocker (ARB) or a calcium channel blocker (CCB) improves prognosis of hemodialysis (HD) patients. Methods: This study was designed as a multicenter prospective cohort study. HD patients ( n = 1071) were enrolled from 22 institutes in January 2009 and followed up for 3 years. Patients with missing data, kidney transplantation or retraction of consent during the follow-up period ( n = 204) were excluded, and 867 patients contributed to analysis of mortality. Propensity score (PS) for use of ARB and that for CCB was calculated using a multiple logistic regression model. Results: ARB and CCB were prescribed in 45.6 and 54.7 % of patients at enrollment. During the 3-year follow-up period, all-cause mortality and cardiovascular mortality rates were 18.8 and 5.1 %, respectively. Kaplan-Meier curves showed that all-cause and cardiovascular mortality rates were lower in the ARB group than in the non-ARB group, though the mortality rates were similar in the CCB group and non-CCB group. In PS-stratified Cox regression analysis, ARB treatment was associated with 34 and 45 % reduction of all-cause death and cardiovascular death, respectively. In PS matching analysis, ARB treatment was associated with a significant reduction (46 % reduction) in the risk of all-cause death. A significant impact of CCB treatment on all-cause or cardiovascular mortality was not detected in PS analysis. Conclusions: The use of an ARB, but not a CCB, is associated with reduced all-cause and cardiovascular mortalities in patients on HD.
- Subjects
HEMODIALYSIS patients; KIDNEY transplantation; ANGIOTENSIN II; HEMODIALYSIS; CARDIOVASCULAR diseases
- Publication
Clinical & Experimental Nephrology, 2016, Vol 20, Issue 3, p469
- ISSN
1342-1751
- Publication type
Article
- DOI
10.1007/s10157-015-1182-3