Effect of angiotensin-converting enzyme inhibitors versus that of angiotensin receptor blockers on survival in patients undergoing hemodialysis: a nationwide observational cohort study

Abstract

Background

This study aimed to evaluate the patient survival rates based on the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in a large cohort of patients undergoing maintenance hemodialysis (HD).

Methods

Data from a national HD quality assessment program were used in this retrospective study. The patients were classified into four groups based on the use of renin-angiotensin system blockers (RASBs) as follows: No group, patients without a prescription of any anti-hypertensive drugs including RASBs; Other group, patients with a prescription of anti-hypertensive drugs excluding RASBs; ACEI group, patients with a prescription of an ACEI; and ARB group, patients with a prescription of an ARB.

Results

The 5-year survival rates in the no, other, ACEI, and ARB groups were 68.6%, 67.8%, 70.6%, and 69.2%, respectively. The ACEI group had the best patient survival trend among the four groups. In multivariable Cox regression analyses, no differences were observed between the ACEI and ARB groups. Among young patients and patients without diabetes or heart disease, the ACEI group had the best patient survival among the four groups. However, among patients with DM or heart disease, the ARB group had the best patient survival.

Conclusions

Our study found that patients receiving ACEI and ARB had comparable survival. However, patients receiving ARB had better survival in the subgroups of patients with DM or heart disease, and patients receiving ACEI had better survival in the subgroup of young patients or patients without diabetes or heart disease.

Keywords:

• Hemodialysis
• mortality
• angiotensin-converting enzyme inhibitor
• angiotensin receptor blocker

Acknowledgments

The epidemiologic data used in this study were obtained from Periodic HD Quality Assessment by HIRA. The requirement for informed consent was waived due to the retrospective nature of the study. De-identifcation was performed, and data usage was permitted by the National Health Information Data Request Review Committee of HIRA.

Statement of ethics

This study was approved by the Institutional Review Board of Yeungnam University Medical Center (approval no. YUMC 2022-01-010). The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The Institutional Review Boarders waived the requirement for informed consent because of the retrospective study design and the anonymization and de-identification of patient records and information before the analysis.

Disclosure statement

The authors declare no competing interests.

Author contributions

SH Kang conceptualized and designed the study, and performed the analysis. BY Kim, EJ Son, and GO Kim generated and collected the data. SH Kang, BY Kim, EJ Son, and GO Kim interpretation of data. SH Kang and JY Do wrote the manuscript. All authors approved the final version of the manuscript.

Data availability statement

The raw data were generated at the HIRA Service. The database can be requested from the HIRA Service by sending a study proposal including the purpose of the study, study design, and duration of analysis through an e-mail ([email protected]) or at the web site (https://www.hira.or.kr). The authors cannot distribute the data without permission.

Additional information

Funding

This work was supported by the Medical Research Center Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science, ICT, and Future Planning (2022R1A5A2018865), the Basic Science Research Program through the NRF of Korea, funded by the Ministry of Education (2022R1I1A3072966), and the NRF grant funded by the Korea government (MSIT) (2022R1F1A1076151). This research was supported by a grant from the Joint Project on Quality Assessment Research, Republic of Korea. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.