Tanaka Marenao, Yamashita Tomohisa, Koyama Masayuki, Moniwa Norihito, Ohno Kohei, Mitsumata Kaneto, Itoh Takahito, Furuhashi Masato, Ohnishi Hirofumi, Yoshida Hideaki, Tsuchihashi Kazufumi, Miura Tetsuji
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan.
Clin Exp Nephrol. 2016 Jun;20(3):469-78. doi: 10.1007/s10157-015-1182-3. Epub 2015 Oct 24.
It is controversial whether treatment with an angiotensin II receptor blocker (ARB) or a calcium channel blocker (CCB) improves prognosis of hemodialysis (HD) patients.
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.
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.
The use of an ARB, but not a CCB, is associated with reduced all-cause and cardiovascular mortalities in patients on HD.
使用血管紧张素II受体阻滞剂（ARB）或钙通道阻滞剂（CCB）治疗是否能改善血液透析（HD）患者的预后存在争议。
本研究设计为一项多中心前瞻性队列研究。2009年1月从22家机构招募了HD患者（n = 1071），并随访3年。排除随访期间有缺失数据、接受肾移植或撤回同意书的患者（n = 204），867例患者参与死亡率分析。使用多元逻辑回归模型计算使用ARB和CCB的倾向评分（PS）。
入组时分别有45.6%和54.7%的患者使用ARB和CCB。在3年随访期内，全因死亡率和心血管死亡率分别为18.8%和5.1%。Kaplan-Meier曲线显示，ARB组的全因和心血管死亡率低于非ARB组，而CCB组和非CCB组的死亡率相似。在PS分层Cox回归分析中，ARB治疗分别使全因死亡和心血管死亡降低34%和45%。在PS匹配分析中，ARB治疗使全因死亡风险显著降低（降低46%）。在PS分析中未检测到CCB治疗对全因或心血管死亡率有显著影响。
HD患者使用ARB而非CCB与全因和心血管死亡率降低相关。
