ACE inhibitors and survival of hemodialysis patients.
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).


CONCLUSIONS
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.
Efrati
Shai
S
Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel. efratishai@barak-online.net
Zaidenstein
Ronit
R
Dishy
Victor
V
Beberashvili
Ilia
I
Sharist
Moshe
M
Averbukh
Zhan
Z
Golik
Ahuva
A
Weissgarten
Joshua
J
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis
D000806:Angiotensin-Converting Enzyme Inhibitors