Original Investigations: Dialysis Therapies
ACE inhibitors and survival of hemodialysis patients*,**

https://doi.org/10.1053/ajkd.2002.36340Get rights and content

Abstract

Background: Cardiovascular disease is a leading cause of death in patients with end-stage renal disease (ESRD). Hypertension is a major risk factor for cardiovascular complications in these patients. Angiotensin-converting enzyme (ACE) inhibitors are an effective treatment for hypertension in patients with ESRD and are known to improve prognosis in patients with chronic renal failure. We investigated their effect on mortality in patients undergoing long-term hemodialysis therapy. Methods: Clinical data for patients on hemodialysis therapy between 1994 and 2000 were reviewed. Patients were grouped according to whether they had been treated with ACE inhibitors. Results: Sixty patients had been treated with ACE inhibitors (treated group) and 66 patients had not (untreated group). Blood pressure reduction was not significantly different between the treated and untreated groups. Nevertheless, comparing the treated group with the untreated group, mortality was decreased significantly in the treated group, with a risk reduction of 52% (rate ratio [RR], 0.482; confidence interval [CI], 0.25 to 0.91; P < 0.0019). In treated patients 65 years or younger, the absolute risk reduction of mortality was 79% (RR, 0.211; CI, 0.08 to 0.58; P < 0.0006). Conclusion: Although further research is needed, these preliminary findings suggest that ACE inhibitors, independently of their antihypertensive effect, may dramatically reduce mortality among chronic hemodialysis patients 65 years or younger. Am J Kidney Dis 40:1023-1029. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Methods

Clinical data and details of medical treatment were extracted from charts of 177 patients on hemodialysis therapy between January 1994 and December 2000 at our medical center. Patients were excluded if they were on dialysis therapy for less than 1 year before data collection, had undergone kidney transplantation, left the hemodialysis unit, had a mean Kt/V less than 1 during the follow-up period, or clinical information was inadequate. Kt/V was calculated using a single-pool model by the

Results

Of 177 patients with ESRD who started hemodialysis therapy between 1994 and 1999, a total of 23 patients underwent kidney transplantation, 9 patients left the unit, and 15 patients had a mean Kt/V less than 1 because of vascular problems. In the records of 4 patients, clinical data were inadequate. The study population therefore included 126 chronic hemodialysis patients. Mean follow-up was 59 months (range, 8 to 113 months).

At the start of dialysis therapy, 66 patients (52%) were administered

Discussion

ACE inhibitors can limit the detrimental effect of angiotensin II on the cardiovascular system and kidneys, ameliorating functional and structural changes produced by progressive renal insufficiency. Clinical trials in patients both with and without diabetes indicate a favorable effect of ACE inhibitors in delaying the progression of renal disease.22 Moreover, the Heart Outcome Prevention Evaluation study showed a decrease in mortality associated with treatment with the ACE inhibitor ramipril

Acknowledgements

The authors thank Pearl Lilos, BSc, from the Laboratory of Statistics, Department of Mathematics, Tel-Aviv University, for assistance with statistical analysis.

References (38)

  • S MacMahon et al.

    Randomized, placebo-controlled trial of the angiotensin-converting enzyme inhibitor, ramipril, in patients with coronary or other occlusive arterial disease. Part 2. Collaborative Research Group. Prevention of Atherosclerosis With Ramipril

    J Am Coll Cardiol

    (2000)
  • A Levin

    Anemia and left ventricular hypertrophy in chronic kidney disease populations: A review of the current state of knowledge

    Kidney Int

    (2002)
  • K Hayashi et al.

    Effects of angiotensin-converting enzyme inhibitors on the treatment of anemia with erythropoietin

    Kidney Int

    (2001)
  • B Kestenbaum et al.

    Calcium channel blocker use and mortality among patients with end-stage renal disease

    Kidney Int

    (2002)
  • AJ Luik et al.

    Influence of interdialytic weight gain on blood pressure in hemodialysis patients

    Blood Purif

    (1994)
  • RL Converse et al.

    Sympathetic overactivity in patients with chronic renal failure

    N Engl J Med

    (1996)
  • BA Markewitz et al.

    Role of intrarenal endothelin in the generation and maintenance of hypertension

    Miner Electrolyte Metab

    (1995)
  • P Vallance et al.

    Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure

    Lancet

    (1992)
  • The Heart Outcomes Prevention Evaluation Study Investigators

    Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients

    N Engl J Med

    (2000)
  • Cited by (0)

    *

    Address reprint requests to Shai Efrati, MD, Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin 70300, Israel. E-mail: [email protected]

    **

    0272-6386/02/4005-0018$35.00/0

    View full text