title: Relationship between calcium channel blocker class and mortality in dialysis.
abstract: OBJECTIVE
  The comparative effectiveness of dihydropyridine (DHP) and non-DHP calcium channel blockers (CCBs) in maintenance dialysis patients has not been well-studied.
  
  
  METHODS
  A retrospective cohort of hypertensive patients initiating dialysis was created. New CCB initiators, defined as individual who had no evidence of CCB use in the first 90 days of dialysis but who were initiated by day 180, were followed from their first day of medication exposure until event or censoring; events consisted of all-cause mortality (ACM) and a combined endpoint of cardiovascular morbidity or mortality (CVMM). Cox proportional hazards models were used to determine adjusted hazard ratios (AHRs) comparing the effect of DHPs vs. non-DHPs.
  
  
  RESULTS
  There were 2900 and 2704 new initiators of CCBs in the ACM and CVMM models, respectively. Adjusted for other factors, use of DHPs, compared to non-DHPs, was associated with an AHR of 0.77 (99% confidence intervals, 0.64 - 0.93, P = 0.0004) for ACM and 0.86 (0.72 - 1.02, P = 0.024) for CVMM. Results were similar when individuals who initiated therapy at any point after the cohort inception were included, with AHRs of 0.60 (0.53 - 0.69, P < 0.0001) and 0.77 (0.67 - 0.89, P < 0.0001) for ACM and CVMM, respectively. Further, elimination of individuals with chronic atrial fibrillation resulted in AHRs of 0.71 and 0.70 for ACM and CVVM, respectively.
  
  
  CONCLUSIONS
  DHPs, as compared to non-DHPs, were associated with reduced hazard of death or cardiovascular morbidity and mortality; potential mechanisms of action require further study.
authors.affiliation: Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.|Chronic Disease Research Group, Minneapolis, MN, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.affiliation: Departments of Biostatistics.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mahnken
authors.affiliation: Departments of Biostatistics.
authors.forename: Milind A
authors.initials: MA
authors.lastname: Phadnis
authors.affiliation: Preventive Medicine and Public Health, Kansas City, KS, USA.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.affiliation: Preventive Medicine and Public Health, Kansas City, KS, USA.|The Kidney Institute, University of Kansas School of Medicine, Kansas City, KS, USA.
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
mesh_terms: D002121:Calcium Channel Blockers / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D004095:Dihydropyridines / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States
chemical_list: D002121:Calcium Channel Blockers; D004095:Dihydropyridines; C038806:1,4-dihydropyridine
keywords: calcium channel blockers; comparative effectiveness; dialysis; end stage renal disease; hypertension; mortality; pharmacoepidemiology