Skip to main content
SpringerLink
Log in

Impact of use of angiotensin II receptor blocker on all-cause mortality in hemodialysis patients: prospective cohort study using a propensity-score analysis

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

It is controversial whether treatment with an angiotensin II receptor blocker (ARB) or a calcium channel blocker (CCB) improves prognosis of hemodialysis (HD) patients.

Methods

This study was designed as a multicenter prospective cohort study. HD patients (n = 1071) were enrolled from 22 institutes in January 2009 and followed up for 3 years. Patients with missing data, kidney transplantation or retraction of consent during the follow-up period (n = 204) were excluded, and 867 patients contributed to analysis of mortality. Propensity score (PS) for use of ARB and that for CCB was calculated using a multiple logistic regression model.

Results

ARB and CCB were prescribed in 45.6 and 54.7 % of patients at enrollment. During the 3-year follow-up period, all-cause mortality and cardiovascular mortality rates were 18.8 and 5.1 %, respectively. Kaplan–Meier curves showed that all-cause and cardiovascular mortality rates were lower in the ARB group than in the non-ARB group, though the mortality rates were similar in the CCB group and non-CCB group. In PS-stratified Cox regression analysis, ARB treatment was associated with 34 and 45 % reduction of all-cause death and cardiovascular death, respectively. In PS matching analysis, ARB treatment was associated with a significant reduction (46 % reduction) in the risk of all-cause death. A significant impact of CCB treatment on all-cause or cardiovascular mortality was not detected in PS analysis.

Conclusions

The use of an ARB, but not a CCB, is associated with reduced all-cause and cardiovascular mortalities in patients on HD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Shafi T, Waheed S, Zager PG. Hypertension in hemodialysis patients: an opinion-based update. Semin Dial. 2014;27:146–53.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Iseki K, Nkai S, Shinzato T, et al. Prevalence and determinants of hypertension in chronic hemodialysis patients in Japan. Ther Apher Dial. 2007;11:183–8.

    Article  PubMed  Google Scholar 

  3. Agarwal R, Nissenson AR, Batlle D, et al. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med. 2003;115:291–7.

    Article  PubMed  Google Scholar 

  4. Argilés A, Lorho R, Servel MF, et al. Seasonal modifications in blood pressure are mainly related to interdialytic body weight gain in dialysis patients. Kidney Int. 2004;65:1795–801.

    Article  PubMed  Google Scholar 

  5. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45: S1-S153.

  6. Canaud B, Lertdumrongluk P. Probing ‘dry weight’ in haemodiaysis patients: ‘back to the future’. Nephrol Dial Transplant. 2012;27:2140–3.

    Article  PubMed  Google Scholar 

  7. Ishimitsu T, Ohta S, Takahashi T, et al. Long-term antihypertensive effects of aliskiren, a direct renin inhibitor, in chronic hemodialysis patients. Ther Apher Dial. 2013;17:524–31.

    CAS  PubMed  Google Scholar 

  8. De Mello WC, Frohlich ED. Clinical perspectives and fundamental aspects of local cardiovascular and renal renin-angiotensin system. Front Endocrinol. 2014;5:16.

    Google Scholar 

  9. Yang LY, Ge X, Wang YL, et al. Angiotensin receptor blockers reduce left ventricular hypertrophy in dialysis patients: a meta analysis. Am J Med Sci. 2013;345:1–9.

    Article  PubMed  Google Scholar 

  10. Sinha AD, Agarwal R. Should all hypertensive dialysis patients receive a blocker of the Renin-Angiotensin system? Curr Hypertens Rep. 2010;12:356–63.

    Article  PubMed  Google Scholar 

  11. Austin PC. The performance of different propensity score methods for estimating marginal hazard ratios. Stat Med. 2013;32:2837–49.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Luo Z, Gardiner JC, Bradley CJ. Applying propensity socore methods in medical research: pittfalls and prospects. Med Care Res Rev. 2010;67:528–54.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Rosenbaum PR, Rubin DB. Reducing bias in obsevational studies using subclassification on the propensity score. J Am Stat Assoc. 1984;79:516–24.

    Article  Google Scholar 

  14. Rosenbaum PR, Rubin DB. Constructing a control group using multivariate mathed sampling methods that incorporate the propensity score. Am Stat. 1985;39:33–8.

    Google Scholar 

  15. Tang CH, Chen TH, Whang CC, et al. Renin-angiotensin system blokade in heart failure patients on long-term haemodialysis in Taiwan. Eur J Heart Fail. 2013;15:1194–202.

    Article  CAS  PubMed  Google Scholar 

  16. Chan KE, Ikizler TA, Gamboa JL, et al. Combied angiotensin-coverting enzyme inhibition and receptor blockade associate with increased risk of cardiovascular death in hemodialysis patients. Kidney Int. 2011;80:978–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wu CK, Yang YH, Juang JM, et al. Effects of angiotensin converting enzyme inhibition or angiotensin receptor blockade in dialysis patients: a nationwide data survey and propensity analysis. Medicine. 2015;94:e424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Takahashi A, Takase H, Toriyama T, et al. Candesartan, a angiotensin II type-1 receptor, reduces cardiovascular events in patients on chronic haemodialysis-a randomized study. Nephrol Dial Transplant. 2006;21:2507–12.

    Article  CAS  PubMed  Google Scholar 

  19. Suzuki H, Kannno Y, Sugahara S, et al. Effect of angiotensin receptor blockers on cardiovascular events in patients undergoing hemo dialysis: an open-label randomized controlled trial. Am J Kidney Dis. 2008;52:501–6.

    Article  CAS  PubMed  Google Scholar 

  20. Iseki K, Arima H, Kohagura K, et al. Effects of angiotensin receptor blockade (ARB) on mortality and cardiovascular outcomes in patients with long-term haemodialysis: a randomized control trial. Nephrol Dial Transplent. 2013;28:1579–89.

    Article  CAS  Google Scholar 

  21. Zannad F, Kessler M, Lehert P, et al. Prevention of cardiovascular events in end-stage renal disease: results of a randomized trial of fosinopril and implications for future studies. Kidney Int. 2006;70:1318–24.

    Article  CAS  PubMed  Google Scholar 

  22. Peters CD, Kjaergaard KD, Jensen JD, et al. No significant effect of angiotensin II receptor blockade on intermediate cardiovascular end point in hemodialysis patients. Kidney Int. 2014;86:625–37.

    Article  CAS  PubMed  Google Scholar 

  23. Kestenbaum B, Gillen DL, Sherrard DJ, et al. Calcium channel blocker use and mortality amoung patients with end-stage renal disease. Kidney Int. 2002;61:2157–64.

    Article  CAS  PubMed  Google Scholar 

  24. Tepel M, Hopfenmueller W, Scholze A, et al. Effect of amlodipine on cardiovascular events in hypertensive haemodialysis patients. Nephrol Dial Transplent. 2008;23:3605–12.

    Article  CAS  Google Scholar 

  25. Heerspink HJ, Ninomiya T, Zoungas S, et al. Effect of lowering blood pressure on cardiovascular events and mortality in patientson dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2009;373:1009–15.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

BOREAS HD study Investigators include Masatada Fukuoka, Makoto Hagiwara, Koichi Hasegawa, Manabu Hayashi, Toshiya Ishiguro, Row Ishimoto, Yosuke Itoh, Toshihiro Iwamoto, Hironori Kobayashi, Hiroshi Kobayashi, Atsushi Konno, Setsuko Kuroda, Tomoaki Matsumoto, Tamaki Matsumoto, Hiroya Murakami, Takahiro Nishitani, Fumio Obara, Toru Ohtomo, Yusuke Okazaki, Norie Saito, Takashi Sakamoto, Niro Sawai, Katsuo Suzuki, Yoshitoki Takagawa, Hideki Takizawa, Kazushi Tanaka, Nobuhiko Togashi, Takaaki Torii, Daisuke Yoshida, Mayumi Yoshihara, and Atsushi Wada.

Author information

Authors and Affiliations

  1. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan

    Marenao Tanaka, Tomohisa Yamashita, Masayuki Koyama, Norihito Moniwa, Kohei Ohno, Kaneto Mitsumata, Takahito Itoh, Masato Furuhashi, Hirofumi Ohnishi, Hideaki Yoshida, Kazufumi Tsuchihashi & Tetsuji Miura

Authors
  1. Marenao Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohisa Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayuki Koyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Norihito Moniwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kohei Ohno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaneto Mitsumata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahito Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masato Furuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hirofumi Ohnishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hideaki Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kazufumi Tsuchihashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tetsuji Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

BOREAS HD study Investigators

Corresponding author

Correspondence to Marenao Tanaka.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Additional information

The members of the “BOREAS HD study Investigators” are given in the Acknowledgments.

Electronic supplementary material

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanaka, M., Yamashita, T., Koyama, M. et al. Impact of use of angiotensin II receptor blocker on all-cause mortality in hemodialysis patients: prospective cohort study using a propensity-score analysis. Clin Exp Nephrol 20, 469–478 (2016). https://doi.org/10.1007/s10157-015-1182-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-015-1182-3

Keywords

Search

Navigation