Renin-angiotensin system inhibition and mortality in patients undergoing dialysis with coronary artery disease: insights from a multi-center observational study.

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Expert Review of Clinical Pharmacology Pub Date : 2024-10-23 DOI:10.1080/17512433.2024.2419915

Enmin Xie, Shuoyan An, Yaxin Wu, Zixiang Ye, Xuecheng Zhao, Yike Li, Nan Shen, Yanxiang Gao, Jingang Zheng

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引用次数: 0

Abstract

Background: While the survival benefits of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are firmly established in the general population, their efficacy within patient undergoing dialysis with coronary artery disease (CAD) remains controversial.

Methods: Between January 2015 and June 2021, 1168 patients undergoing dialysis with CAD were assessed from 30 tertiary medical centers. The primary outcome was all-cause death, and the secondary outcome was cardiovascular death. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for between-group differences.

Results: Overall, ACEI or ARB were prescribed to 518 patients (44.3%) upon discharge. After a median follow-up of 22.2 months, 361 (30.9%) patients died, including 243 cardiovascular deaths. The use of ACEI or ARB was associated with a significantly lower risk of all-cause (25.3% vs 35.4%, hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52-0.82, p < 0.001) and cardiovascular death (17.0% vs 23.8%; HR 0.64, 95% CI 0.48-0.83, p = 0.001). These findings remained consistent across IPTW and PSM analyses. Sensitivity analyses for ACEI and ARB use separately yielded similar results.

Conclusions: Our findings suggested that among patients undergoing dialysis with CAD, ACEI or ARB use was associated with a lower risk of all-cause and cardiovascular death.

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肾素-血管紧张素系统抑制与冠心病透析患者的死亡率：一项多中心观察研究的启示。

背景：虽然血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）对普通人群的生存益处已得到证实，但它们对接受透析的冠状动脉疾病（CAD）患者的疗效仍存在争议：2015年1月至2021年6月期间，30家三级医疗中心对1168名接受透析治疗的冠心病患者进行了评估。主要结果为全因死亡，次要结果为心血管死亡。为考虑组间差异，进行了逆概率治疗加权（IPTW）和倾向评分匹配（PSM）：共有 518 名患者（44.3%）在出院时接受了 ACEI 或 ARB 治疗。中位随访 22.2 个月后，361 名患者（30.9%）死亡，其中 243 人死于心血管疾病。使用 ACEI 或 ARB 可显著降低全因风险（25.3% vs 35.4%，危险比 [HR] 0.65，95% 置信区间 [CI] 0.52-0.82，P = 0.001）。这些结果在IPTW和PSM分析中保持一致。对分别使用 ACEI 和 ARB 的敏感性分析也得出了相似的结果：我们的研究结果表明，在患有 CAD 的透析患者中，使用 ACEI 或 ARB 与较低的全因死亡和心血管死亡风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.30

自引率

2.30%

发文量

127

期刊介绍： Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.