Two blood pressure drugs are linked to 16 percent lower risk for heart attacks, strokes, and death in patients with end-stage renal disease who are undergoing peritoneal dialysis, according to recent research.
The study, “Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and cardiovascular outcomes in patients initiating peritoneal dialysis,” was published in the journal Nephrology Dialysis Transplantation.
Patients with end-stage renal disease (ESRD) experience high potential for cardiovascular (CV) disease. Among 20 percent of patients who pass away during the first year after dialysis begins, 42 percent of the deaths are attributed to CV.
In patients with chronic kidney disease (CKD) not on dialysis, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) slow the progression of diabetic nephropathy and reduce CV risk. However, data on those treatments in patients with ESRD have been mixed. Three randomized clinical trials involving patients with ESRD on hemodialysis and one in kidney transplant recipients previously found no reduction in CV outcomes with the use of an ACEI or ARB.
To investigate the association between ACEI/ARB use and CV outcomes in patients initiating peritoneal dialysis (PD), researchers recently used the United States Renal Data System for records on all adult patients starting the treatment from 2007 to 2011 and taking part in Medicare Part D, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users.
Of the 4,879 patients identified, the researchers found that 42 percent used ACEIs or ARBs. A review of outcomes revealed that patients who had filled prescriptions for the blood pressure drugs had a reduced risk of heart attacks, strokes and death.
“While randomized clinical trials are needed to test whether this is a causal relationship, these findings indicate doctors should consider using or re-starting ACEIs and ARBs as first-line blood pressure medications for patients undergoing peritoneal dialysis,” Dr. Jenny I. Shen, an LA BioMed researcher and corresponding author of the study, said in a news release. “These medications are often stopped when patients are in the late, but pre-dialysis, stages of kidney disease because of the risk of dangerously high potassium levels. The risk of higher potassium levels is minimized after patients have transitioned to peritoneal dialysis, but doctors often don’t resume the medication even though it can usually be re-started safely.”