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The effectiveness and safety of angiotensin-converting enzyme inhibition or receptor blockade in vascular diseases in patients with hemodialysis.

Abstract Patients with end-stage renal disease (ESRD) who are on hemodialysis have high risk of vascular diseases. Our study sought to examine whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin type 1 receptor blockers (ARBs) could reduce the frequencies of cardiovascular and cerebrovascular events in patients receiving hemodialysis using the medication possession ratio (MPR) method of analysis.This retrospective cohort study identified cases of ESRD with dialysis from the National Health Insurance Research Database between 1999 and 2006, and used Cox-regression methods to evaluate risk of poor outcomes. Primary outcomes, including death from any cause, and secondary outcomes, including admission for stroke, myocardial infarction, and heart failure, were examined.Compared to the nonuser group, the adjusted HRs for mortality of the nonadherence group and the adherence group were 0.81 (95% CI: 0.76-0.86) and 0.98 (95% CI: 0.86-1.13), respectively. Cardiovascular events were more frequent in patients with ESRD receiving ACEIs /ARBs than in nonusers. Compared with nonusers, the hazard of secondary outcome significantly increased in the nonadherence group or adherence group in 10 years follow-up.Compared with patients with diabetes or chronic kidney disease, patients on hemodialysis may not experience the same cardiovascular and cerebrovascular benefits from ACEIs/ARBs use.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28353612
OWN - NLM
STAT- MEDLINE
DA  - 20170329
DCOM- 20170406
LR  - 20170406
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 13
DP  - 2017 Mar
TI  - The effectiveness and safety of angiotensin-converting enzyme inhibition or
      receptor blockade in vascular diseases in patients with hemodialysis.
PG  - e6525
LID - 10.1097/MD.0000000000006525 [doi]
AB  - Patients with end-stage renal disease (ESRD) who are on hemodialysis have high
      risk of vascular diseases. Our study sought to examine whether
      angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin type 1 receptor
      blockers (ARBs) could reduce the frequencies of cardiovascular and
      cerebrovascular events in patients receiving hemodialysis using the medication
      possession ratio (MPR) method of analysis.This retrospective cohort study
      identified cases of ESRD with dialysis from the National Health Insurance
      Research Database between 1999 and 2006, and used Cox-regression methods to
      evaluate risk of poor outcomes. Primary outcomes, including death from any cause,
      and secondary outcomes, including admission for stroke, myocardial infarction,
      and heart failure, were examined.Compared to the nonuser group, the adjusted HRs 
      for mortality of the nonadherence group and the adherence group were 0.81 (95%
      CI: 0.76-0.86) and 0.98 (95% CI: 0.86-1.13), respectively. Cardiovascular events 
      were more frequent in patients with ESRD receiving ACEIs /ARBs than in nonusers. 
      Compared with nonusers, the hazard of secondary outcome significantly increased
      in the nonadherence group or adherence group in 10 years follow-up.Compared with 
      patients with diabetes or chronic kidney disease, patients on hemodialysis may
      not experience the same cardiovascular and cerebrovascular benefits from
      ACEIs/ARBs use.
FAU - Liao, Kuang-Ming
AU  - Liao KM
AD  - aDepartment of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan
      bDepartment of Nephrology cDepartment of Pharmacy, National Taiwan University
      Hospital Hsin-Chu Branch, Hsinchu dSchool of Pharmacy, Master Program in Clinical
      Pharmacy, Kaohsiung Medical University eDepartment of Pharmacy, Kaohsiung Medical
      University Hospital, Kaohsiung, Taiwan, R.O.C.
FAU - Cheng, Hui-Teng
AU  - Cheng HT
FAU - Lee, Yi-Hsuan
AU  - Lee YH
FAU - Chen, Chung-Yu
AU  - Chen CY
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angiotensin II Type 1 Receptor Blockers/*therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Cardiovascular Diseases/etiology/*prevention & control
MH  - Female
MH  - Humans
MH  - Kidney Failure, Chronic/*complications/mortality/therapy
MH  - Male
MH  - Medication Adherence
MH  - Middle Aged
MH  - Renal Dialysis
MH  - Retrospective Studies
MH  - Taiwan/epidemiology
EDAT- 2017/03/30 06:00
MHDA- 2017/04/07 06:00
CRDT- 2017/03/30 06:00
AID - 10.1097/MD.0000000000006525 [doi]
AID - 00005792-201703310-00058 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Mar;96(13):e6525. doi: 10.1097/MD.0000000000006525.