This article is more than 5 years old. Information may no longer be current.
Two BP medications lower fatal CV outcomes in peritoneal dialysis
Click Here to Manage Email Alerts
Researchers have linked ACE inhibitors and angiotensin II receptor blockers to a decreased risk for fatal CV outcomes in patients initiating peritoneal dialysis.
“... [T]hese findings indicate doctors should consider using or restarting [ACE inhibitors and angiotensin II receptor blockers] as first-line [BP] medications for patients undergoing peritoneal dialysis,” Jenny I. Shen, MD, from Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, said in a press release. “These medications are often stopped when patients are in the late, but pre-dialysis, stages of kidney disease because of the risk of dangerously high potassium levels. The risk [for these] levels is minimized after patients have transitioned to peritoneal dialysis, but doctors often don’t resume the medication, even though it can usually be restarted safely.”
Jenny I. Shen
Researchers analyzed data from the U.S. Renal Data System on 4,879 adult patients who initiated peritoneal dialysis and participated in Medicare Part D for the first 90 days. Of that cohort, 2,063 (42%) used ACE inhibitors or angiotensin II receptor blockers.
The outcomes of interest were a composite of death, ischemic stroke and MI, and each of the components individually. Median follow-up was 1.2 years.
During the study period, there were 1,771 events, or 25 per 100 person-years, according to the researchers.
Shen and colleagues found use of ACE inhibitors or angiotensin II receptor blockers vs. nonuse was linked to a decreased risk for the composite CV outcome (HR = 0.84; 95% CI, 0.76-0.93), as well as all-cause mortality (HR = 0.83; 95% CI, 0.75-0.92) and CV death (HR = 0.74; 95% CI, 0.63-0.87). Use of the BP medications did not confer a lower risk for MI (HR = 0.88; 95% CI, 0.69-1.12) or ischemic stroke (HR = 1.06; 95% CI, 0.79-1.43).
“Our study has potential implications for clinical practice,” the researchers wrote. “While we found [ACE inhibitor/angiotensin II receptor blocker] use is common among incident patients on [peritoneal dialysis], it is not as high as it could be, judging by the prevalence of hypertension and the use of other antihypertensives in nonusers. ... [ACE inhibitors/angiotensin II receptor blockers] are not being used as first-line antihypertensives despite several national guidelines that recommend use for those with diabetic nephropathy with proteinuria and those on [peritoneal dialysis] with residual renal function.”
The researchers also cautioned that because the cohort was restricted to those receiving Medicare Part D, the results may not be similar in younger patients who do not qualify for the benefit. – by James Clark
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts