DOPPS data suggest a possible survival benefit of renin angiotensin-aldosterone system inhibitors and other antihypertensive medications for hemodialysis patients

The benefits of renin angiotensin-aldosterone system inhibitors (RAASi) are well-established in the general population, particularly among those with diabetes, congestive heart failure (CHF), or coronary artery disease (CAD). However, conflicting evidence from trials and concerns about hyperkalemia limit RAASi use in hemodialysis patients, relative to other antihypertensive agents, including beta blockers and calcium channel blockers. Therefore, we investigated prescription patterns and associations with mortality for RAASi and other antihypertensive agents using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Cox regression was used to estimate the effect of the prescription of RAASi and other antihypertensive agents at study entry on mortality in 11,421 incident (120 days or less) hemodialysis and 37,124 prevalent (over 120 days) hemodialysis patients from DOPPS phases 2-5 (2002-2015). Over 95% of RAASi were angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. RAASi prevalence was 39% and varied minimally by CHF and CAD. The adjusted hazard ratio for RAASi (vs. no RAASi) was 0.89 (95% confidence interval 0.80-0.99) among incident and 0.94 (0.90-0.99) among prevalent hemodialysis patients, with no convincing evidence of interaction with diabetes, CAD or CHF. Inverse associations with mortality were also observed for beta blockers and calcium channel blockers, and were stronger for angiotensin receptor blockers than angiotensin-converting enzyme inhibitors, but this latter finding requires further study. Thus, our observations suggest a relatively small survival benefit of RAASi and other antihypertensive agents in hemodialysis patients, though randomized prospective studies are needed to potentially change prescribing criteria. The benefits of renin angiotensin-aldosterone system inhibitors (RAASi) are well-established in the general population, particularly among those with diabetes, congestive heart failure (CHF), or coronary artery disease (CAD). However, conflicting evidence from trials and concerns about hyperkalemia limit RAASi use in hemodialysis patients, relative to other antihypertensive agents, including beta blockers and calcium channel blockers. Therefore, we investigated prescription patterns and associations with mortality for RAASi and other antihypertensive agents using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Cox regression was used to estimate the effect of the prescription of RAASi and other antihypertensive agents at study entry on mortality in 11,421 incident (120 days or less) hemodialysis and 37,124 prevalent (over 120 days) hemodialysis patients from DOPPS phases 2-5 (2002-2015). Over 95% of RAASi were angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. RAASi prevalence was 39% and varied minimally by CHF and CAD. The adjusted hazard ratio for RAASi (vs. no RAASi) was 0.89 (95% confidence interval 0.80-0.99) among incident and 0.94 (0.90-0.99) among prevalent hemodialysis patients, with no convincing evidence of interaction with diabetes, CAD or CHF. Inverse associations with mortality were also observed for beta blockers and calcium channel blockers, and were stronger for angiotensin receptor blockers than angiotensin-converting enzyme inhibitors, but this latter finding requires further study. Thus, our observations suggest a relatively small survival benefit of RAASi and other antihypertensive agents in hemodialysis patients, though randomized prospective studies are needed to potentially change prescribing criteria. Renin angiotensin-aldosterone system inhibitors (RAASi), a group of antihypertensive medication classes that predominantly includes angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), have been shown to improve outcomes for individuals without kidney failure at increased risk of cardiovascular (CV) events.1Zaman M.A. Oparil S. Calhoun D.A. Drugs targeting the renin-angiotensin-aldosterone system.Nat Rev Drug Discov. 2002; 1: 621-636Crossref PubMed Scopus (351) Google Scholar, 2Dickstein K. Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal trial in myocardial infarction with angiotensin II antagonist losartan.Lancet. 2002; 360: 752-760Abstract Full Text Full Text PDF PubMed Scopus (1061) Google Scholar, 3Wing L.M. Reid C.M. Ryan P. et al.A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretics for hypertension in the elderly.N Engl J Med. 2003; 348: 583-592Crossref PubMed Scopus (1049) Google Scholar, 4Healey J.S. Baranchuk A. Crystal E. et al.Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis.J Am Coll Cardiol. 2005; 45: 1832-1839Crossref PubMed Scopus (706) Google Scholar, 5Mancini G.B. Etminan M. Zhang B. et al.Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease.J Am Coll Cardiol. 2006; 47: 2554-2560Crossref PubMed Scopus (370) Google Scholar, 6Papademetriou V. Farsang C. Elmfeldt D. et al.Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE).J Am Coll Cardiol. 2004; 44: 1175-1180PubMed Google Scholar, 7Young J.B. Dunlap M.E. Pfeffer M.A. et al.Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials.Circulation. 2004; 110: 2618-2626Crossref PubMed Scopus (328) Google Scholar A meta-analysis of 25 randomized trials also demonstrated a decreased risk of CV events for RAASi versus placebo in patients with chronic kidney disease.8Balamuthusamy S. Srinivasan L. Verma M. et al.Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis.Am Heart J. 2008; 155: 791-805Crossref PubMed Scopus (88) Google Scholar Blood pressure–lowering agents have been shown to be effective in reducing CV events and all-cause mortality in patients with kidney failure treated with hemodialysis (HD),9Heerspink H.J. Ninomiya T. Zoungas S. et al.Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials.Lancet. 2009; 373: 1009-1015Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar but the risk-benefit ratio for RAASi use specifically is unknown. A key concern is that hyperkalemia is a common side effect of RAASi; hyperkalemia is a risk factor for mortality, especially in HD patients,10Karaboyas A. Zee J. Brunelli S.M. et al.Dialysate potassium, serum potassium, mortality, and arrhythmia events in hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).Am J Kidney Dis. 2017; 69: 266-277Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 11Kovesdy C.P. Regidor D.L. Mehrotra R. et al.Serum and dialysate potassium concentrations and survival in hemodialysis patients.Clin J Am Soc Nephrol. 2007; 2: 999-1007Crossref PubMed Scopus (246) Google Scholar, 12Genovesi S. Valsecchi M.G. Rossi E. et al.Sudden death and associated factors in a historical cohort of chronic haemodialysis patients.Nephrol Dial Transplant. 2009; 24: 2529-2536Crossref PubMed Scopus (127) Google Scholar because diminished renal potassium excretion causes disturbances in heart rhythm and can lead to cardiac arrest.13Perazella M.A. Mahnensmith R.L. Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis.J Gen Intern Med. 1997; 12: 646-656Crossref PubMed Scopus (93) Google Scholar HD patients have a significant comorbidity D.A. et of and mortality in hemodialysis patients in and the the Dialysis Outcomes and Practice Patterns Study Am Soc Nephrol. 2003; PubMed Scopus Google Scholar and CV that those in the general et and mortality among patients 2009; PubMed Scopus Google Scholar HD patients for randomized trial evidence of CV and mortality outcomes in HD is because trial results have been A. S. et of to angiotensin-converting enzyme inhibitors on mortality and morbidity in hemodialysis patients with chronic heart failure a Am Coll Cardiol. PubMed Scopus Google Scholar, A. T. et angiotensin II receptor cardiovascular events in patients on chronic randomized Dial Transplant. 2006; PubMed Scopus Google Scholar, S. et al.Effect of angiotensin receptor blockers on cardiovascular events in patients hemodialysis: randomized controlled J Kidney Dis. 2008; Full Text Full Text PDF PubMed Scopus Google Scholar, K. K. et of angiotensin receptor blockade on mortality and cardiovascular outcomes in patients with a randomized controlled Dial Transplant. PubMed Scopus Google Scholar, M. P. et al.Prevention of cardiovascular events in renal results of a randomized trial of and for 2006; Full Text Full Text PDF PubMed Scopus Google Scholar, R. et in hemodialysis patients treated with or a randomized controlled Dial Transplant. PubMed Scopus Google Scholar concerns about hyperkalemia have to prescription patterns among M.A. Mahnensmith R.L. Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis.J Gen Intern Med. 1997; 12: 646-656Crossref PubMed Scopus (93) Google Scholar, hyperkalemia by inhibitors of the Engl J Med. 2004; PubMed Scopus Google Scholar, R. S. of kidney with cardiovascular medication use after myocardial J Am Soc Nephrol. 2008; PubMed Scopus Google Scholar, P. J. R. et patterns of agents for left ventricular systolic among hemodialysis J Kidney Dis. 2006; Full Text Full Text PDF PubMed Scopus Google Scholar, L.M. M. et of hyperkalemia and in chronic kidney Intern Med. 2009; PubMed Scopus Google Scholar, T. M. S. et renin-angiotensin-aldosterone system blocker use in chronic kidney disease in a PubMed Scopus Google Scholar A of P. J. R. et patterns of agents for left ventricular systolic among hemodialysis J Kidney Dis. 2006; Full Text Full Text PDF PubMed Scopus Google Scholar the use of antihypertensive agents that the common for prescribing for HD patients was about Therefore, RAASi are in HD patients relative to other antihypertensive calcium channel blockers and diuretics is a this we investigated patterns of RAASi prescription and the RAASi use and mortality in international cohort of HD that the benefits of RAASi use in CV risk reduction and kidney S. et al.Effect of inhibitors of the system and other antihypertensive drugs on renal systematic review and 2005; Full Text Full Text PDF PubMed Scopus Google Scholar, et of chronic kidney the of blood pressure and angiotensin-converting enzyme a Intern Med. 2003; PubMed Scopus Google Scholar, et and of angiotensin-converting enzyme inhibitors in kidney disease.J Am Soc Nephrol. 2007; PubMed Scopus Google Scholar the survival we also that RAASi use especially 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RAASi prescription was associated with all-cause mortality among incident HD patients and a mortality among prevalent HD patients, with no evidence of to our diabetes, or CHF. Inverse associations with mortality were also observed for and and stronger for than trials of RAASi in HD patients have from A. T. et angiotensin II receptor cardiovascular events in patients on chronic randomized Dial Transplant. 2006; PubMed Scopus Google Scholar, S. et al.Effect of angiotensin receptor blockers on cardiovascular events in patients hemodialysis: randomized controlled J Kidney Dis. 2008; Full Text Full Text PDF PubMed Scopus Google Scholar of HD patients that the CV was in the group randomized to than in the K. K. et of angiotensin receptor blockade on mortality and cardiovascular outcomes in patients with a randomized controlled Dial Transplant. PubMed Scopus Google Scholar in outcomes for versus the et M. 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P. et al.Prevention of cardiovascular events in renal results of a randomized trial of and for 2006; Full Text Full Text PDF PubMed Scopus Google Scholar with A S. and angiotensin-converting enzyme in patients with renal disease and acute myocardial Am Coll Cardiol. 2003; PubMed Scopus Google Scholar of infarction use in patients and individuals on mortality for in though prevalence was in the of hyperkalemia finding that RAASi prescription by of CHF or CAD is because use is for patients with in the general evidence is in patients, use for patients with Kidney for cardiovascular disease in J Kidney Dis. 2005; 45: Scholar of the for the by CAD or CHF. of studies of RAASi have been studies have demonstrated a RAASi use and chronic kidney disease S. et al.Effect of inhibitors of the system and other antihypertensive drugs on renal systematic review and 2005; Full Text Full Text PDF PubMed Scopus Google Scholar, et of chronic kidney the of blood pressure and angiotensin-converting enzyme a Intern Med. 2003; PubMed Scopus Google Scholar, et and of angiotensin-converting enzyme inhibitors in kidney disease.J Am Soc Nephrol. 2007; PubMed Scopus Google Scholar the other observed that of RAASi to kidney in studies of chronic kidney disease M. The of inhibitors of the system in patients with chronic kidney Dial Transplant. PubMed Scopus Google Scholar, M.A. renal failure in chronic kidney disease patients with renal artery on renin angiotensin system a prospective 2008; PubMed Scopus Google Scholar A randomized trial is S. et randomized controlled trial of angiotensin-converting enzyme receptor blocker in renal the Dial Transplant. PubMed Google Scholar to this our study of HD patients, have kidney especially those in our prevalent HD and results from our incident HD cohort of RAASi on mortality or in kidney Hyperkalemia is a key concern for HD patients,10Karaboyas A. Zee J. Brunelli S.M. et al.Dialysate potassium, serum potassium, mortality, and arrhythmia events in hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).Am J Kidney Dis. 2017; 69: 266-277Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 11Kovesdy C.P. Regidor D.L. Mehrotra R. et al.Serum and dialysate potassium concentrations and survival in hemodialysis patients.Clin J Am Soc Nephrol. 2007; 2: 999-1007Crossref PubMed Scopus (246) Google Scholar, 12Genovesi S. Valsecchi M.G. Rossi E. et al.Sudden death and associated factors in a historical cohort of chronic haemodialysis patients.Nephrol Dial Transplant. 2009; 24: 2529-2536Crossref PubMed Scopus (127) Google Scholar and was prevalent among patients been on is in a study to the RAASi use and RAASi use serum but patients with serum were a reducing the and results from a study by et A. et system blockade and the risk of hyperkalemia in chronic hemodialysis J Med. 2002; Full Text Full Text PDF PubMed Scopus Google Scholar Hyperkalemia can be treated or by the with the latter used have on but observed prescription of diuretics and in patients and were used in our especially in but for RAASi use in a of HD patients, is a of our was to estimate the effect of RAASi prescription on all-cause mortality, our study also a of international in RAASi prescription patterns in HD patients the by on and that prescription prescription in HD patients, was observed by et et of antihypertensive agents to haemodialysis and associations with and survival in the Dial Transplant. 2009; 24: PubMed Scopus Google Scholar in of DOPPS data increased of in is with the of and also have been by trial results among HD A. 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T. et angiotensin II receptor cardiovascular events in patients on chronic randomized Dial Transplant. 2006; PubMed Scopus Google Scholar, S. et al.Effect of angiotensin receptor blockers on cardiovascular events in patients hemodialysis: randomized controlled J Kidney Dis. 2008; Full Text Full Text PDF PubMed Scopus Google Scholar, K. K. et of angiotensin receptor blockade on mortality and cardiovascular outcomes in patients with a randomized controlled Dial Transplant. PubMed Scopus Google Scholar, M. P. et al.Prevention of cardiovascular events in renal results of a randomized trial of and for 2006; Full Text Full Text PDF PubMed Scopus Google Scholar that used to estimate the of RAASi in HD of our are to the of HD patients in this the study of of medication data in a of the DOPPS phases and were to we were to for serum in the the to is especially in this to the and of and 95% than on of associations were R.L. 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