title: Angiotensin Converting Enzyme Inhibitor Dialyzability and Outcomes in Older Patients Receiving Hemodialysis.
abstract: OBJECTIVE
  Some angiotensin converting enzyme (ACE) inhibitors are efficiently removed from circulation by hemodialysis ('high dialyzability'), whereas others are not ('low dialyzability'). In patients receiving hemodialysis, this may influence the effectiveness of ACE inhibitors.
  
  
  METHODS
  Using linked healthcare databases we identified older patients receiving chronic hemodialysis who filled new ACE inhibitor prescriptions. The low dialyzability group (n = 3,369) included fosinopril and ramipril. The high dialyzability group (n = 5,974) included enalapril, lisinopril, and perindopril. The primary outcome was all-cause mortality within 180 days of first ACE inhibitor prescription.
  
  
  RESULTS
  There were 361 deaths among 5,974 patients (6.0%) prescribed with low dialyzability ACE inhibitors and 179 deaths among 3,369 patients (5.3%) prescribed with high dialyzability ACE inhibitors (relative risk 1.1, 95% CI 0.9-1.3, p = 0.6).
  
  
  CONCLUSIONS
  In this study of older patients receiving hemodialysis, the dialyzability of ACE inhibitors was not associated with mortality or cardiovascular outcomes.
authors.affiliation: Department of Medicine, Division of Nephrology, Western University, London, Ont., Canada.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Weir
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Fleet
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Dixon
authors.forename: Arsh K
authors.initials: AK
authors.lastname: Jain
authors.forename: Matthew
authors.initials: M
authors.lastname: Oliver
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Chris
authors.initials: C
authors.lastname: McIntyre
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D004656:Enalapril / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D017328:Fosinopril / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D018056:Hemorheology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D007688:Kidneys, Artificial; D017706:Lisinopril / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D017257:Ramipril / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004656:Enalapril; D017706:Lisinopril; D017257:Ramipril; D017328:Fosinopril; D020913:Perindopril