Shen Jenny I, Saxena Anjali B, Montez-Rath Maria E, Chang Tara I, Winkelmayer Wolfgang C
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson St., C-1 Annex, Torrance, CA, USA.
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
Nephrol Dial Transplant. 2017 May 1;32(5):862-869. doi: 10.1093/ndt/gfw053.
Data on the effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in reducing cardiovascular (CV) risk in patients undergoing peritoneal dialysis (PD) are limited. We investigated the association between ACEI/ARB use and CV outcomes in patients initiating PD.
In this observational cohort study, we identified from the United States Renal Data System all adult patients who initiated PD from 2007 to 2011 and participated in Medicare Part D, a federal prescription drug benefits program, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users. We applied Cox regression to an inverse probability of treatment weighted cohort to estimate the hazard ratios (HRs) for the combined outcome of death, ischemic stroke or myocardial infarction (MI) and each outcome individually.
Among 4879 patients, 2063 (42%) used an ACEI/ARB. Patients were followed up for a median of 1.2 years. We recorded 1771 events, for a composite rate of 25 events per 100 person-years. ACEI/ARB use (versus nonuse) was associated with a reduced risk of the composite outcome {HR 0.84 [95% confidence interval (CI) 0.76-0.93]}, all-cause mortality [HR 0.83 (95% CI 0.75-0.92)] and CV death [HR 0.74 (95% CI 0.63-0.87)], but not MI [HR 0.88 (95% CI 0.69-1.12)] or ischemic stroke [HR 1.06 (95% CI 0.79-1.43)]. Results were similar in as-treated analyses. In a subgroup analysis, we did not find any effect modification by residual renal function.
ACEI/ARB use is common in patients initiating PD and is associated with a lower risk of fatal CV outcomes.
关于血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）在降低腹膜透析（PD）患者心血管（CV）风险方面有效性的数据有限。我们研究了开始进行PD的患者使用ACEI/ARB与CV结局之间的关联。
在这项观察性队列研究中，我们从美国肾脏数据系统中确定了2007年至2011年开始进行PD并在透析的前90天参加联邦处方药福利计划医疗保险D部分的所有成年患者。在这90天内开具了ACEI或ARB处方的患者被视为使用者。我们将Cox回归应用于治疗加权队列的逆概率，以估计死亡、缺血性中风或心肌梗死（MI）联合结局以及每个单独结局的风险比（HR）。
在4879例患者中，2063例（42%）使用了ACEI/ARB。患者的中位随访时间为1.2年。我们记录了1771例事件，复合发生率为每100人年25例事件。使用ACEI/ARB（与未使用相比）与复合结局风险降低相关{HR 0.84 [95%置信区间（CI）0.76 - 0.93]}、全因死亡率[HR 0.83（95% CI 0.75 - 0.92）]和CV死亡[HR 0.74（95% CI 0.63 - 0.87）]，但与MI[HR 0.88（95% CI 0.69 - 1.12）]或缺血性中风[HR 1.06（95% CI 0.79 - 1.43）]无关。在实际治疗分析中结果相似。在亚组分析中，我们未发现残余肾功能对结果有任何影响修正作用。
开始进行PD的患者中使用ACEI/ARB很常见，且与致命性CV结局风险较低相关。
