Oreopoulos DG, Bargman JM, Fang W
ACE Inhibitors/ARB and Survival in Patients on Peritoneal Dialysis.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol
(Nov) 18:708A 2007

Objective: Angiotensin-converting enzyme (ACE) inhibitors have been shown to
improve outcome in patients with renal failure not on dialysis therapy and
patients on hemodialysis (HD). However, their effect on survival has not been
studied in peritoneal dialysis (PD) patients. The present study examined the
association between therapy with ACE inhibitor/ ARB and mortality in patients
undergoing chronic PD.
Methods: All patients who commenced PD between
January 1, 2000, and December 31, 2005 at the University Health Network were
included. Patients were grouped according to whether they had been treated
with ACE inhibitor/ARB. They were followed up from the date of PD initiation
until death, cessation of PD, transfer to other centers or to the end of the
study (December 31, 2006).
Results: A total of 306 patients were
included in the study. 165 were treated with ACE inhibitors/ARB (treated
group) and 141 had not (untreated group). The treated group were younger
(56.9
16.6 vs 62.3
17.8 years, p<0.01) and had higher blood pressure (systolic:
138.8
21.8 vs 128.6
22.4 mmHg, diastolic: 79.8
14.1 vs
74.5
12.5, both p<0.01) at the initiation of
PD. The treated group had a significantly longer survival compared to the
untreated group (Log Rank 19.191, p<0.001). After adjusting for age, blood
pressure and other demographic and clinical parameters, multivariable Cox
proportional hazards modeling showed that use of ACE inhibitor/ARB was
associated with 60% reduced risk for death (HR 0.397, 95%CI 0.241-0.653,
p<0.001).
Conclusion: In this retrospective analysis, ACE
inhibitor/ARB therapy was associated with a dramatically reduced mortality in
patients on peritoneal dialysis independent of achieved blood pressure and
other clinical and demographic variables.
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