Use of angiotensin-converting-enzyme inhibitor is related to improvement of all-cause mortality in patients with maintenance hemodialysis

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  • Omae Kiyotsugu
    Department of Internal Medicine, Yoshikawa Clinic Department of Internal Medicine, Medical Center East, Tokyo Women’s Medical University
  • Ogawa Tetsuya
    Department of Internal Medicine, Medical Center East, Tokyo Women’s Medical University
  • Yoshikawa Masao
    Department of Internal Medicine, Yoshikawa Clinic
  • Sakura Hiroshi
    Department of Internal Medicine, Medical Center East, Tokyo Women’s Medical University
  • Nitta Kosaku
    4th Department of Internal Medicine, Tokyo Women’s Medical University

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Other Title
  • 透析患者におけるACE阻害薬治療と生命予後 : 傾向スコアマッチング法を用いた検討
  • トウセキ カンジャ ニ オケル ACE ソガイヤク チリョウ ト セイメイ ヨゴ : ケイコウ スコアマッチングホウ オ モチイタ ケントウ

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Renin-angiotensin system inhibitors (RASI), having superior therapeutic effects on cardiovascular outcome beyond blood-pressure lowering, have been widely used for dialysis patients. In this study, we investigated the effect of angiotensinII receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) on mortality for patients with maintenance dialysis in Yoshikawa Clinic. Dialysis outpatients in our clinic had been registered in our dialysis-patient database from April 2006 onwards, and followed up prospectively with collection of their clinical and laboratory data. Each propensity score of our whole cohort was calculated by multiple logistic regression analysis using the absence/presence of RASI as the objective variable. The three groups, non-RASI group and ACEI and ARB groups from the RASI group, were extracted by a propensity score-matching method. Comparisons among the three groups were made by log-rank test between their survival curves of death due to disease as the endpoint. A total of 347 dialysis patients had been registered in our database by July 2013 and 93 of these, consisting of 31 matched trios, were extracted. Eligible patients were 54 males and 39 females, with an average age of 67.1 years, and their duration of dialysis was 4.3 years at the start of observation. Blood pressure and laboratory data were not significantly different among the three groups under good control. A total of 30 patients died in the observation period (mean follow-up period was 4.2 years) and 19 patients died due to cardiovascular disease. The ACEI group showed better prognosis in terms of all-cause mortality than the ARB group ; however, cardiovascular death was not significantly different among the three groups. In the ACEI group, all-cause mortality of maintenance dialysis patients was suppressed ; however, the use of ARB did not affect their prognosis. A randomized prospective multi-center study is needed in the future.

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