Antihypertensive medications and risk of death and hospitalizations in US hemodialysis patients

Shafi, Tariq; Sozio, Stephen M.; Luly, Jason; Bandeen‐Roche, Karen; Peter, Wendy L. St.; Ephraim, Patti L.; McDermott, Aidan; Herzog, Charles A.; Crews, Deidra C.; Scialla, Julia J.; Tangri, Navdeep; Miskulin, Dana C.; Michels, Wieneke M.; Jaar, Bernard G.; Zager, Philip G.; Meyer, Klemens B.; Wu, Albert W.; Boulware, L. Ebony

doi:10.1097/md.0000000000005924

Cited by 15 publications

(11 citation statements)

References 49 publications

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“…Clinical studies are not very helpful in this respect. Whereas a large observational analysis in >44,000 HD patients reported a higher mortality risk in individuals on a β‐blocker‐based regimen than a RAS‐inhibitor based regimen, opposite findings were found in a RCT, comparing atenolol with lisinopril . As CONTRAST was executed over a time‐span of >5 years and the prescription of β‐blockers was not prespecified, our results may be confounded by a varying indication and thus not reflect causality.…”

Section: Discussioncontrasting

confidence: 60%

Left ventricular geometric patterns in end‐stage kidney disease: Determinants and course over time

Nubé¹,

Hoekstra²,

Doganer³

et al. 2018

Hemodialysis International

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The finding that previous CVD was positively associated with eLVH may result from the permanent high cardiac output and the strong tendency for aortic valve calcification in this group of long-term hemodialysis patients, who suffer generally also from chronic anemia and various other metabolic derangements. No association was found between eLVH and parameters of fluid balance. The distribution of left ventricular geometry did not alter over time. The assumption that LV geometry worsens over time in susceptible individuals, who then suffer from a high risk of dying, may explain these findings.

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Section: Discussioncontrasting

confidence: 60%

Left ventricular geometric patterns in end‐stage kidney disease: Determinants and course over time

Nubé¹,

Hoekstra²,

Doganer³

et al. 2018

Hemodialysis International

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“…The increasing use of ACE I and beta blockers in dialysis patients with comorbid conditions like congestive heart failure and the benefits thereof were noted in the literature and was reflected in the common use of these medications in this study [ 34 ]. For example studies of USRDS data noted that beta blockers use had increased 75% in those with previous acute myocardial infarctions and ACEI and ARB use had increased in those with CHF [ 35 , 36 ]. In the survey, once on HD, the majority did not change ACEI (like enalapril, one third of which is dialyzed out) to one that would not be removed by dialysis, despite existing guidelines to do so.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns in transitioning patients from chronic kidney disease to dialysis: a survey of United States nephrologists

et al. 2018

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BackgroundThere are no guidelines for transitioning patients from chronic kidney disease stage 5 to hemodialysis. We conducted this study to determine if there are uniform patterns in how nephrologists transition patients to dialysis.MethodsWe designed an electronic survey with 39 questions and sent it to a database of practicing nephrologists at the National Kidney Foundation. Factors that were important for transitioning a patient to hemodialysis were evaluated, including medication changes on dialysis initiation, dry weight and dialysis prescription.Results160 US Nephrologists replied to the survey; 18% (29/160) of the responses were completed via social media sites. Prior to dialysis, 74% (118/160), prescribed furosemide and 67% (107/160) used furosemide with metolazone. Once dialysis started, only 46% (74/160) of the responders continued patients on diuretics daily. Hypertension medications prescribed in dialysis were calcium channel blockers 69% (112/160), beta blockers 36% (58/160), angiotensin converting enzyme inhibitor 32% (53/160), angiotensin receptor blocker 29% (46/160) and diuretics 25% (42/160). Once dialysis started, 68% (109/160) routinely changed medications. Most, 67% (107/160) ordered patients to avoid anti-hypertensive medications on dialysis days to allow for ultrafiltration. Dry weight was determined in the first week by 29% (46/160) and in the first month by 53% (85/160). Most, 59% (94/160) felt that multiple causes lead to hypertension. Most nephrologists would prescribe small dialyzers and a shorter period of time for the first dialysis session.ConclusionThe transition period to chronic hemodialysis has variations in practice patterns and may benefit from further studies to optimize clinical practice.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0943-0) contains supplementary material, which is available to authorized users.

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“…In general, these patients are of older age with frequent comorbidities and abundant concomitant medication [21, 22]. We evaluated the safety and efficacy of PrOD regimen in a group of 23 patients, including 4 patients with severe renal impairment and 19 patients on maintenance haemodialysis, all infected with HCV genotype 1.…”

Section: Introductionmentioning

confidence: 99%

Paritaprevir/Ritonavir/Ombitasvir Plus Dasabuvir Regimen in the Treatment of Genotype 1 Chronic Hepatitis C Infection in Patients with Severe Renal Impairment and End-Stage Renal Disease: a Real-Life Cohort

Šperl

Kreidlová

Merta

et al. 2018

Kidney Blood Press Res

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Background/Aims: Chronic hepatitis C (HCV) virus infection reactivates under immunosuppressive drugs and therefore has a negative impact on long-term survival of kidney transplant recipients. Treatment-induced clearance of hepatitis C virus (HCV) in kidney transplant candidates prevents virus reactivation after transplantation. Paritaprevir/Ritonavir/Ombitasvir with Dasabuvir (PrOD) represents a highly effective treatment regimen for HCV genotype 1 (GT1), also suitable for patients with end-stage renal disease (ESRD). Serious drug-drug interactions may represent a limiting factor of this regimen. The aim of this retrospective study was to evaluate safety, efficacy and drug-drug interactions management associated with PrOD treatment in the Czech real-world cohort. Methods: Emphasizing concomitant medication adjustment, we described the treatment course with PrOD regimen in 23 patients (4 with CKD4 and 19 on maintenance haemodialysis) infected with HCV GT1 (21 GT1b, 2 GT1a), 18 males and 5 females with an average age of 53.7 years. Six patients had compensated liver cirrhosis and 3 of them were liver transplant recipients. Results: All 23 patients completed the 12-week treatment and achieved sustained virological response 12 weeks after the treatment (SVR12 rate 100%). None of the patients presented with a significant decrease in haemoglobin level, white blood cell and platelet count during the treatment period. The most frequent adverse events were nausea, hypotension, diarrhoea, and hyperkalemia. Four patients presented with a serious adverse event unrelated to the antiviral drugs (salmonellosis, non-functional kidney graft rejection, early gastric cancer, renal cyst infection, initiation of haemodialysis). Concomitant medication had to be modified with the treatment initiation in 10 out of 23 (43.5%) patients (calcium channel blockers, ACE inhibitors, statins, diuretics, tacrolimus); four patients required further adjustment of antihypertensive drugs or tacrolimus dosage on-treatment. Conclusion: PrOD regimen demonstrated an excellent efficacy and good tolerability. Both prospective adjustment of concomitant medication and further on-treatment adjustment allowed for a safe treatment course.

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Antihypertensive medications and risk of death and hospitalizations in US hemodialysis patients

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 49 publications

Left ventricular geometric patterns in end‐stage kidney disease: Determinants and course over time

Left ventricular geometric patterns in end‐stage kidney disease: Determinants and course over time

Practice patterns in transitioning patients from chronic kidney disease to dialysis: a survey of United States nephrologists

Paritaprevir/Ritonavir/Ombitasvir Plus Dasabuvir Regimen in the Treatment of Genotype 1 Chronic Hepatitis C Infection in Patients with Severe Renal Impairment and End-Stage Renal Disease: a Real-Life Cohort

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