Higher Survival Rates of Chronic Hemodialysis Patients on Anti-Hypertensive Drugs

Iseki, Kunitoshi; Tanaka, Shōji; Nakai, Shigeru; Watanabe, Yoshihiko; Akiba, Takashi; Tsubakihara, Yoshiharu

doi:10.1159/000232600

Cited by 31 publications

(24 citation statements)

References 66 publications

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“…Iseki et al examined the relationship between BP and anti-hypertensive drugs therapy in HD patients, and found that one-year mortality rate was significantly lower in patients prescribed anti-hypertensive drugs than in those non-prescribed. They refer to effect of the prescription of anti-hypertensive drugs on good prognosis of HD patients [19]. In fact, the percentage of the patients prescribed anti-hypertensive drugs was higher in non-CCVD patients than in CCVD patients in this study (66% vs. 33%).…”

Section: Discussionmentioning

confidence: 56%

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Long-Term Survival of Patients with IgA Nephropathy After Dialysis Therapy

Komatsu

Kikuchi

Nakagawa

et al. 2013

Kidney Blood Press Res

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Background/Aims: How dialysis affects the survival of patients with biopsy-proven IgA nephropathy (IgAN) is not fully understood. The present long-term cohort study quantifies the survival rates and incidence of cardio-cerebrovascular diseases (CCVDs) among such patients in Japan. Methods: Fifty-two of 433 patients with IgAN who had reached end-stage kidney disease underwent renal replacement therapy (RRT) between 1981 and 2010. The overall survival rate and incidence of CCVDs in these patients were evaluated during follow-up for 11.3 ± 6.4 years. Results: The mean age at starting RRT was 42.8 ± 13.3 years. Only seven patients died during follow-up (mortality rate, 1.2/100 person-years) and Kaplan-Meier analysis revealed favorable survival rates of 93.3% and 65.1% at 10 and 20 years, respectively, compared with that of patients with glomerulonephritis in the registry of the Japanese Society for Dialysis Therapy who required RRT. Malignancy and CCVDs were causes of death at 13.6 ± 4.8 and 3.9 ± 1.3 years, respectively, after starting RRT. Fatal and non-fatal CCVDs developed in 15 (incidence, 2.7/100 person-years) patients and acute coronary syndrome and cerebral hemorrhage developed relatively soon after starting RRT. Cox proportional hazards models revealed that age at the time of starting RRT was a significant factor affecting the onset of CCVDs. Meanwhile, a history of having had corticosteroid as an initial treatment did not affect the onset of events. Conclusion: Although the survival of patients with IgAN is favorable after dialysis, the onset of CCVDs during the early phase of dialysis should be carefully monitored.

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Section: Discussionmentioning

confidence: 56%

“…Finally, some race-related factors might be associated with the long survival and low incidence of CCVDs because all of our study patients were Japanese. In fact, rates of mortality and comorbid diseases differ among countries [19,22]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival of Patients with IgA Nephropathy After Dialysis Therapy

Komatsu

Kikuchi

Nakagawa

et al. 2013

Kidney Blood Press Res

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“…Although several randomized control trials (RCTs) showed that RASI reduced the incidence of deaths, patient numbers were small and the studies used an open-label design [9-12]. Similar results were obtained from observational studies, but these did not estimate the effect of ACEI and ARB separately [13-15] and did not consider the possibility of time-dependent confounding: blood pressure (BP) levels probably associated with mortality [16] are both affected by previous RASI use and influence the future prescription of RASI. This time-dependent confounding cannot be adjusted appropriately and produces bias if conventional analysis such as time-dependent Cox regression is used [17, 18].…”

Section: Introductionmentioning

confidence: 89%

Interactive Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers or Their Combination on Survival of Hemodialysis Patients

Kido¹,

Akizawa

Fukagawa

et al. 2017

Am J Nephrol

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Background: Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. Methods: We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. Results: Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50–0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57–1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22–5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. Conclusion: Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations.

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“…Almost all patients have past history of hypertension before starting dialysis and have taken multiple anti-hypertensive medications. It has been reported by several cohort studies including JSDT registry [26] and metaanalyses [27,28] that BP control by anti-hypertensive drugs leads to better cardiovascular outcomes. However, any optimal regimen to control BP and to reduce mortality has not yet been established.…”

Section: Treatment By Anti-hypertensive Drugs For Hd Patientsmentioning

confidence: 99%

Management of hypertension for patients undergoing dialysis therapy

Taniyama

2016

Ren Replace Ther

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Hypertension is very prevalent among patients undergoing dialysis therapy: hemodialysis (HD) and peritoneal dialysis (PD). Although it is recognized as a great risk of cardiovascular mortality for these populations, how to regulate blood pressure (BP) is poorly understood. For HD patients, we should pay much attention to methods of measuring BP. Outof-center BP levels and BP variability should be evaluated by ambulatory BP monitoring and home BP measurement because they are closely associated with cardiovascular mortality. Although target BP levels are not clear, several clinical guidelines suggest <140/90 mmHg. However, it must be determined for each individual patient with careful considerations about comorbidities. Based on the underling pathophysiology of hypertension in patients on dialysis, maintaining an appropriate volume of body fluid by dietary salt restriction and optimization of dry weigh should be considered as a first line therapy. Inhibitors for renin-angiotensin system may be suitable to reduce BP and mortality for those patients on dialysis. These drugs may also be effective for preserving residual renal function and peritoneal function for PD patients. β-blockers may have potentials to improve survival for HD patients and can be added to antihypertensive medications. Lacking large-scale and good quality clinical trials, there are many questions to be answered. Much effort should continuously be made to create evidences for better management of hypertension for patients on dialysis therapy.

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Higher Survival Rates of Chronic Hemodialysis Patients on Anti-Hypertensive Drugs

Cited by 31 publications

References 66 publications

Long-Term Survival of Patients with IgA Nephropathy After Dialysis Therapy

Long-Term Survival of Patients with IgA Nephropathy After Dialysis Therapy

Interactive Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers or Their Combination on Survival of Hemodialysis Patients

Management of hypertension for patients undergoing dialysis therapy

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