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dc.contributor.author | Kido, Ryo | en |
dc.contributor.author | Akizawa, Tadao | en |
dc.contributor.author | Fukagawa, Masafumi | en |
dc.contributor.author | Onishi, Yoshihiro | en |
dc.contributor.author | Yamaguchi, Takuhiro | en |
dc.contributor.author | Fukuhara, Shunichi | en |
dc.contributor.alternative | 福原, 俊一 | ja |
dc.date.accessioned | 2018-05-21T05:22:02Z | - |
dc.date.available | 2018-05-21T05:22:02Z | - |
dc.date.issued | 2018-01 | - |
dc.identifier.issn | 0250-8095 | - |
dc.identifier.uri | http://hdl.handle.net/2433/231194 | - |
dc.description.abstract | Bachground: Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. Methods: We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8, 229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. Results: Among 3, 762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1, 226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50–0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57–1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22–5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. Conclusion: Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations. | en |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | S. Karger AG | en |
dc.rights | This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. | en |
dc.subject | Angiotensin-converting enzyme inhibitors | en |
dc.subject | Angiotensin receptor blockers | en |
dc.subject | Dialysis | en |
dc.subject | Epidemiology | en |
dc.subject | Mortality | en |
dc.title | Interactive Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers or Their Combination on Survival of Hemodialysis Patients | en |
dc.type | journal article | - |
dc.type.niitype | Journal Article | - |
dc.identifier.jtitle | American Journal of Nephrology | - |
dc.identifier.volume | 46 | - |
dc.identifier.issue | 6 | - |
dc.identifier.spage | 439 | - |
dc.identifier.epage | 447 | - |
dc.relation.doi | 10.1159/000482013 | - |
dc.textversion | publisher | - |
dc.address | Medical Examination Center, Inagi Municipal Hospital・Institute for Health Outcomes and Process Evaluation Research (iHope International) | en |
dc.address | Division of Nephrology, Showa University School of Medicine | en |
dc.address | Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine | en |
dc.address | Institute for Health Outcomes and Process Evaluation Research (iHope International) | en |
dc.address | Division of Biostatistics, Tohoku University Graduate School of Medicine | en |
dc.address | Department of Healthcare Epidemiology, School of Public Health, Kyoto University Faculty of Medicine・Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University | en |
dc.identifier.pmid | 29161689 | - |
dcterms.accessRights | open access | - |
出現コレクション: | 学術雑誌掲載論文等 |
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