NDT Advance Access published online on June 20, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn321
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Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis*
1 Peritoneal Dialysis Program, University Health Network, Toronto, and University of Toronto, Toronto, Ontario, Canada 2 Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Correspondence and offprint requests to: Joanne M. Bargman, University Health Network, Toronto, and University of Toronto, 200 Elizabeth Street 8N-840, Toronto, Ontario M5G 2C4, Canada. Tel: +1-416-340-4804; Fax: +1-416-340-4999; E-mail: joanne.bargman{at}uhn.on.ca
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Abstract |
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Background. Angiotensin-converting enzyme (ACE) inhibitors have been shown to improve outcome in patients with renal failure not on dialysis therapy and patients on haemodialysis (HD). However, their effect on survival has not been studied in peritoneal dialysis (PD) patients. The present study examined the association between therapy with ACE inhibitor/ARB and mortality in patients undergoing chronic PD.
Methods. All patients who commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network were included. Patients were grouped according to whether they had been treated with ACE inhibitor/ARB. They were followed up from the date of PD initiation until death, cessation of PD, transfer to other centres or to the end of the study (31 December 2006).
Results. A total of 306 patients were included in the study. One hundred and sixty-five were treated with ACE inhibitors/ARB (treated group) and 141 were not (untreated group). The treated group patients were younger (56.9 ± 16.6 versus 62.3 ± 17.8 years, P < 0.01) and more likely to have a history of hypertension than the untreated group. At the initiation of PD, systolic and diastolic blood pressures were higher in the treated than the untreated group (138.8 ± 21.8 versus 128.6 ± 22.4 mmHg, P < 0.001; 79.8 ± 14.1 versus 74.5 ± 12.5 mmHg, P = 0.001) and remained significantly higher during the follow-up (133.5 ± 16.4 versus 125.1 ± 16.7 mmHg; 77.3 ± 9.8 versus 73.2 ± 9.7 mmHg, both P < 0.001). The treated group had a significantly longer survival compared to the untreated group (log rank 19.191, P < 0.001). After adjusting for age, blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modelling showed that the use of ACE inhibitor/ARB was associated with 62% reduced risk for death (HR 0.382, 95% CI 0.232–0.631, P < 0.001).
Conclusion. In this retrospective analysis, ACE inhibitor/ARB therapy was associated with a dramatically reduced mortality in patients on peritoneal dialysis independent of blood pressure and other clinical and demographic variables.
Keywords: angiotensin II type 1 receptor blockers (ARB); angiotensin-converting enzyme (ACE) inhibitors; end-stage renal disease (ESRD); peritoneal dialysis (PD); survival
* Presented in part at the 40th Congress of the American Society of Nephrology, 2007.
Received for publication: 27.12.07
Accepted in revised form: 19. 5.08
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