Document Detail


Effect of angiotensin receptor blockers on cardiovascular events in patients undergoing hemodialysis: an open-label randomized controlled trial.
MedLine Citation:
PMID:  18653268     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiovascular disease is the leading cause of mortality in patients with kidney failure treated with hemodialysis (HD). Although angiotensin receptor blockers (ARBs) reduce cardiovascular disease (CVD) events in patients with diabetes and chronic kidney disease, their effect in patients with kidney failure on HD therapy is not known.
STUDY DESIGN: Open-labeled randomized trial.
SETTING & PARTICIPANTS: Patients aged 30 to 80 years receiving HD 2 to 3 times weekly for 1 to 5 years at 5 university-affiliated dialysis centers.
INTERVENTIONS: Treatment with ARBs (valsartan, candesartan, and losartan) versus without ARBs after stratification by sex, age, systolic blood pressure, and diabetes.
OUTCOMES: The primary end point is the development of fatal and nonfatal CVD events, defined as the composite of CVD death, myocardial infarction, stroke, congestive heart failure, coronary artery bypass grafting, or percutaneous coronary intervention. The secondary end point is all-cause death.
RESULTS: 366 subjects initially were randomly assigned to an ARB or no ARB (control), but after a run-in phase, 180 were retained in each group. Mean age was 60 years, 59% were men, 51% had diabetes, and mean predialysis systolic blood pressure was 154 mm Hg. There were 93 fatal or nonfatal CVD events (52%); 34 (19%) in the ARB group and 59 (33%) in the non-ARB group. After adjustment for age, sex, diabetes, systolic blood pressure, and center, treatment with an ARB was independently associated with reduced fatal and nonfatal CVD events (hazard ratio, 0.51; 95% confidence interval, 0.33 to 0.79; P = 0.002). There were 63 deaths (35%); 25 (14%) in the ARB group and 38 (21%) in the non-ARB group. After adjustment, all-cause mortality differed between the 2 groups (hazard ratio, 0.64; 95% confidence interval, 0.39 to 1.06; P = 0.1).
LIMITATIONS: Because of the small sample size of this trial, the large effect may be a spurious finding. Use of an open-label design and 3 different agents in the ARB group might have influenced results.
CONCLUSION: Use of an ARB may be effective in reducing nonfatal CVD events in patients undergoing long-term HD. A larger study is required to confirm these results.
Authors:
Hiromichi Suzuki; Yoshihiko Kanno; Soichi Sugahara; Naofumi Ikeda; Junko Shoda; Tsuneo Takenaka; Tsutomu Inoue; Ryuichiro Araki
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2008-07-24
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  52     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-26     Completed Date:  2008-09-18     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  501-6     Citation Subset:  IM    
Affiliation:
Department of Nephrology, School of Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan. iromichi@saitama-med.ac.jp
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00530595
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers / adverse effects,  therapeutic use*
Benzimidazoles / adverse effects,  therapeutic use
Cardiovascular Diseases / epidemiology,  etiology*,  mortality,  prevention & control*
Female
Humans
Incidence
Kidney Failure, Chronic / therapy*
Losartan / adverse effects,  therapeutic use
Male
Middle Aged
Renal Dialysis / adverse effects*
Tetrazoles / adverse effects,  therapeutic use
Valine / adverse effects,  analogs & derivatives,  therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Benzimidazoles; 0/Tetrazoles; 114798-26-4/Losartan; 137862-53-4/valsartan; 7004-03-7/Valine; S8Q36MD2XX/candesartan
Comments/Corrections
Comment In:
Am J Kidney Dis. 2008 Sep;52(3):400-2   [PMID:  18725012 ]

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