期刊
KIDNEY INTERNATIONAL
卷 94, 期 3, 页码 589-598出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.kint.2018.03.013
关键词
antihypertensive agents; DOPPS; hemodialysis; mortality; reni-nangiotensin-aldosterone system inhibitors
资金
- AstraZeneca
- Dialysis Outcomes and Practice Patterns Study (DOPPS) Program
- Amgen
- Kyowa Hakko Kirin
- Baxter Healthcare
- Association of German Nephrology Centres (Verband Deutsche Nierenzentren e.V.)
- European Renal Association-European Dialysis & Transplant Association (ERA-EDTA)
- German Society of Nephrology (DGfN)
- Hexal AG
- Janssen
- Japanese Society for Peritoneal Dialysis (JSPD)
- Keryx
- Proteon
- Relypsa
- Roche
- Societa Italiana di Nefrologia (SIN)
- Spanish Society of Nephrology
- Vifor Fresenius Medical Care Renal Pharma
- DOPPS projects
- Australia: National Health & Medical Research Council (NHMRC)
- Canada: Canadian Institutes of Health Research (CIHR) and Ontario Renal Network
- France: Agence Nationale de la Recherche
- Thailand: Thailand Research Foundation (TRF)
- Chulalongkorn University Matching Fund
- King Chulalongkorn Memorial Hospital Matching Fund
- National Research Council of Thailand (NRCT)
- United Kingdom: National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN)
- United States: National Institutes of Health (NIH) and Patient-Centered Outcomes Research Institute (PCORI)
- ASTELLAS
- Bellco
- GlaxoSmithKline
- Merck Sharpe and Dohme
- Abbvie
- Menarini
- Vifor
- Alexion
- Baxter
- Janssen-Cilag
- Otsuka
- Vifor-Fresenius Pharma
The benefits of renin angiotensin-aldosterone system inhibitors (RAASi) are well-established in the general population, particularly among those with diabetes, congestive heart failure (CHF), or coronary artery disease (CAD). However, conflicting evidence from trials and concerns about hyperkalemia limit RAASi use in hemodialysis patients, relative to other antihypertensive agents, including beta blockers and calcium channel blockers. Therefore, we investigated prescription patterns and associations with mortality for RAASi and other antihypertensive agents using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Cox regression was used to estimate the effect of the prescription of RAASi and other antihypertensive agents at study entry on mortality in 11,421 incident (120 days or less) hemodialysis and 37,124 prevalent (over 120 days) hemodialysis patients from DOPPS phases 2-5 (2002-2015). Over 95% of RAASi were angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. RAASi prevalence was 39% and varied minimally by CHF and CAD. The adjusted hazard ratio for RAASi (vs. no RAASi) was 0.89 (95% confidence interval 0.80-0.99) among incident and 0.94 (0.90-0.99) among prevalent hemodialysis patients, with no convincing evidence of interaction with diabetes, CAD or CHF. Inverse associations with mortality were also observed for beta blockers and calcium channel blockers, and were stronger for angiotensin receptor blockers than angiotensin-converting enzyme inhibitors, but this latter finding requires further study. Thus, our observations suggest a relatively small survival benefit of RAASi and other antihypertensive agents in hemodialysis patients, though randomized prospective studies are needed to potentially change prescribing criteria.
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