PAPER DETAILS

BACKGROUND
The association between angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) use and mortality in end stage renal disease (ESRD) patients lacks sufficient evidence. We aim to investigate the efficacy of ACEIs and ARBs in ESRD patients.

METHODS
This nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database enrolled ESRD patients from January 1997 to December 2011. Propensity score matching provided two study groups (ACEI/ARB users vs. nonusers) balanced in sample size with similar comorbidities and prescriptions. These patients were followed from the first date of receiving dialysis until mortality, 5 years, or December 31, 2013 (whichever came first). We analyzed the association of the use of ACEIs or ARBs with cardiovascular (CV) death and all-cause mortality in patients with ESRD by using the Kaplan-Meier method and time-dependent Cox models with a robust sandwich variance method.

RESULTS
After propensity score matching, all characteristics of the user of ACEIs or ARBs (n = 17,280) and nonuser (n = 17,280) groups were appropriately balanced (P > .05). In the Cox proportional hazards model, the user group exhibited lower CV death and all-cause mortality with adjusted hazard ratios (HRs) and 95%CI of 0.58 (0.55-0.62) and 0.47 (0.46-0.49) than the nonuser group did. Furthermore, the association of ACEIs/ARBs use with low mortality risk was observed in all examined subgroups.

CONCLUSION
In this large-scale, population-based cohort study, ESRD patients using ACEIs/ARBs had a lower risk of CV death and all-cause mortality than nonusers did. This article is protected by copyright. All rights reserved.