title: Renin-angiotensin system blockade in heart failure patients on long-term haemodialysis in Taiwan.
abstract: OBJECTIVE
  Heart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined.
  
  
  RESULTS
  We conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new-onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e., an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non-RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3-year all-cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0%) occurred during 5272 person-years of follow-up compared with 734 deaths (42.0%) among non-RASB users during 2683 person-years of follow-up. Three-year mortality rates were 45.4% and 49.1% for patients receiving and those not receiving an RASB, respectively (log-rank test, P < 0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all-cause [hazard ratio (HR) 0.8; 95% confidence interval (CI) 0.72-0.89; P < 0.001] and cardiovascular mortality (HR 0.76; 95% CI 0.64-0.90; P < 0.01).
  
  
  CONCLUSIONS
  RASB therapy reduced all-cause and cardiovascular mortality in heart failure patients on long-term haemodialysis.
authors.affiliation: School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chao-Hsiun
authors.initials: CH
authors.lastname: Tang
authors.forename: Tso-Hsiao
authors.initials: TH
authors.lastname: Chen
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Wang
authors.forename: Chuang-Ye
authors.initials: CY
authors.lastname: Hong
authors.forename: Kuan-Chih
authors.initials: KC
authors.lastname: Huang
authors.forename: Yuh-Mou
authors.initials: YM
authors.lastname: Sue
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012084:Renin-Angiotensin System; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACE inhibitor; ARB; Haemodialysis; Heart failure; Mortality; Renin–angiotensin system