The association between renin-angiotensin system blockade and cardiovascular risk in long-term haemodialysis patients in Taiwan

• Main Authors: Yi-Hsuan Lee, 李佾璇
• Other Authors: Tong-Rong Tsai
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/4spjxy

碩士 === 高雄醫學大學 === 藥學研究所碩士在職專班 === 102 === Background: The worldwide incidence and prevalence of End-Stage Renal Disease (ESRD) requiring dialysis is increasing. The incidence and prevalence of patients on dialysis in Taiwan increased rapidly after 1995, the launch year of National Health Insurance (NHI). Compared with patients with normal renal function, patients on long-term dialysis are at increased risk of cardiovascular events, which comprise a major cause of morbidity and mortality Cardiovascular events is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin–angiotensin system (RAS) blocker on the outcomes of these patients have yet to be determined. Methods: The current study conducted a nationwide observational study using data from the Taiwan National Health Insurance Research Database(NHIRD) , between 1997 and 2009. We used the International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes to define the diseases. Our study subjects were patients on long-term HD receiving regular HD more than 3 months during 1999–2006, and the patients were identified through the catastrophic illness registry in the NHIRD. This study was approved by the National Health Research Institute, and all the data are delinked information. Confidentiality was ensured by abiding by the NHI Bureau data regulations. We used the NHIRD between 1997 and 2009 for co-morbidity and follow-up analysis purposes .This study enrolled patients with long term haemodialysis under treatment with medications. We further classified the study sample into two groups. New users of a RAS blocker (RASB; i.e. an ACEi or an ARB ) were selected to compare with non-RASB users. We used Cox proportional hazards regression to compare the risk of all-cause mortality and the incidences of cardiovascular events. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed.We also considered other covariates in this study, including cumulative days taking an RASB, age, gender, urbanization level, medications, and co-morbidities, within the 2 years before the first time received haemodialysis Results: In all, 15434 patients were enrolled in the study. Of these, 7820 patients took an RASB and 7612 patients did not take any RASB. In the treatment group, 2535 patients use ACEI only,1324 patients use ARB only, and 3961 patients replaced the drug use (ACEI to ARB). Those treated with an RASB were younger (66.3 years vs. 68.7 years, P < 0.001), which had a higher prevalence of hypertension (22.59% vs. 15.75%, P < 0.001) and diabetes (33.55% vs. 21.91%, P < 0.001).At the time of enrolment, compared with the patients in the control group, patients in the treatment group more commonly used beta-blockers, calcium channel blockers, alpha-blockers ,diuretics, statins, antiplatelet drugs ,and diabetes drugs. The mean follow-up periods were 1759.78 and 1590.63 days in the treatment and control groups, respectively (P < 0.001) . The primary outcome was all-cause mortality during a follow-up periods. Among RASB users, 2637 deaths compared with 2829 deaths among non-RASB users. mortality rates were 33.8% and 37.1% for patients receiving and those not receiving an RASB. Log-rank tests of unadjusted survival showed a significantly lower mortality rate in the treatment group than in the control group (P <0.001). Conclusion: RASB therapy reduced all-cause mortality in patients on long-term haemodialysis.But this study did not provide a beneficial effect of RASB for the cardiovascular events in long-term HD patients .