title: Use of renin-angiotensin system inhibitors is associated with reduction of fracture risk in hemodialysis patients.
abstract: BACKGROUND
  Patients with chronic kidney disease, especially those undergoing dialysis treatment and having secondary hyperparathyroidism, have a high risk of bone fracture. The renin-angiotensin system (RAS) is associated with osteoclastic bone resorption. We aimed to examine whether the use of RAS inhibitors reduces the incidence of fracture in hemodialysis patients.
  
  
  RESULTS
  This was a multicenter, 3-year, prospective, observational study. From 2008 to 2011, maintenance hemodialysis patients with secondary hyperparathyroidism (N = 3,276) treated with angiotensin converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) at baseline were followed for a mean of 2.7 years. The association between the use of ACEI/ARB and hospitalization rate owing to fracture was examined by using Cox regression models. Effect modifications by the severity of secondary hyperparathyroidism (intact parathyroid hormone [iPTH] level), sex, and systolic blood pressure were also examined. The incidence proportion of fracture-related hospitalization was 5.42% throughout the observation period. ACEI/ARB use was associated with a lower rate of fracture-related hospitalization (adjusted hazard ratio, 0.65; 95% confidence interval [CI], 0.45-0.92). This association was not significantly affected by sex (P = 0.56) or systolic blood pressure levels (P = 0.87). The hazard ratios adjusted by iPTH levels were qualitatively different, but not statistically significant (P = 0.11): 0.77 (95% CI, 0.42-1.39), 0.38 (95% CI, 0.20-0.73), 0.59 (95% CI, 0.29-1.21), and 1.29 (95% CI, 0.58-2.42) for the first, second, third and fourth quartiles of iPTH, respectively.
  
  
  CONCLUSIONS
  Use of RAS inhibitors is associated with a lower rate of fracture-related hospitalization in hemodialysis patients with secondary hyperparathyroidism.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00995163.
authors: Department of Clinical Nephroscience, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
authors: Suguru
authors: S
authors: Yamamoto
authors: Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan; Medical Examination Center, Inagi Municipal Hospital, Tokyo, Japan.
authors: Ryo
authors: R
authors: Kido
authors: Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
authors: Yoshihiro
authors: Y
authors: Onishi
authors: Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
authors: Shingo
authors: S
authors: Fukuma
authors: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors: Tadao
authors: T
authors: Akizawa
authors: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
authors: Masafumi
authors: M
authors: Fukagawa
authors: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Blood Purification Center, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors: Junichiro J
authors: JJ
authors: Kazama
authors: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
authors: Ichiei
authors: I
authors: Narita
authors: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
authors: Shunichi
authors: S
authors: Fukuhara
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors