title: Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and cardiovascular outcomes in patients initiating peritoneal dialysis.
abstract: BACKGROUND
  Data on the effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in reducing cardiovascular (CV) risk in patients undergoing peritoneal dialysis (PD) are limited. We investigated the association between ACEI/ARB use and CV outcomes in patients initiating PD.
  
  
  METHODS
  In this observational cohort study, we identified from the United States Renal Data System all adult patients who initiated PD from 2007 to 2011 and participated in Medicare Part D, a federal prescription drug benefits program, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users. We applied Cox regression to an inverse probability of treatment weighted cohort to estimate the hazard ratios (HRs) for the combined outcome of death, ischemic stroke or myocardial infarction (MI) and each outcome individually.
  
  
  RESULTS
  Among 4879 patients, 2063 (42%) used an ACEI/ARB. Patients were followed up for a median of 1.2 years. We recorded 1771 events, for a composite rate of 25 events per 100 person-years. ACEI/ARB use (versus nonuse) was associated with a reduced risk of the composite outcome {HR 0.84 [95% confidence interval (CI) 0.76-0.93]}, all-cause mortality [HR 0.83 (95% CI 0.75-0.92)] and CV death [HR 0.74 (95% CI 0.63-0.87)], but not MI [HR 0.88 (95% CI 0.69-1.12)] or ischemic stroke [HR 1.06 (95% CI 0.79-1.43)]. Results were similar in as-treated analyses. In a subgroup analysis, we did not find any effect modification by residual renal function.
  
  
  CONCLUSIONS
  ACEI/ARB use is common in patients initiating PD and is associated with a lower risk of fatal CV outcomes.
authors.affiliation: Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson St., C-1 Annex, Torrance, CA, USA.|Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Jenny I
authors.initials: JI
authors.lastname: Shen
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Anjali B
authors.initials: AB
authors.lastname: Saxena
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Montez-Rath
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Tara I
authors.initials: TI
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.|Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; cardiovascular; peritoneal dialysis; renin angiotensin system blockers