Association of Renin-Angiotensin System Blockers with Survival in Patients on Maintenance Hemodialysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Variables
2.3. Statistical Analyses
3. Results
3.1. Clinical Characteristics
3.2. Survival Analyses
3.3. Analyses Using Propensity Score Weights
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Group 1 | Group 2 | Group 3 | p-Value | |
---|---|---|---|---|
Age (years) | 59.8 ± 13.4 | 61.3 ± 12.4 * | 60.2 ± 12.5 *+ | <0.001 |
Sex (male, %) | 16,789 (58.9%) | 5553 (58.0%) | 10,442 (62.1%) | <0.001 |
Hemodialysis vintage (days) | 1329 ± 1715 | 1954 ± 1782 | 1774 ± 1567 *+ | <0.001 |
Underlying cause of ESRD | <0.001 | |||
Diabetes mellitus | 11,940 (41.9%) | 4089 (42.7%) | 8122 (48.3%) | |
Hypertension | 7338 (25.7%) | 2641 (27.6%) | 4430 (26.4%) | |
Glomerulonephritis | 3098 (10.9%) | 1049 (11.0%) | 1657 (9.9%) | |
Other | 2717 (9.5%) | 773 (8.1%) | 1091 (6.5%) | |
Unknown | 3428 (12.0%) | 1019 (10.6%) | 1511 (9.0%) | |
CCI score | 7.4 ± 2.9 | 7.4 ± 2.9 | 7.7 ± 2.9 *+ | <0.001 |
Follow-up duration (days) | 1810 ± 810 | 1895 ± 929 * | 1910 ± 917 * | <0.001 |
Type of vascular access | 0.552 | |||
Arteriovenous fistula | 24,353 (85.4%) | 8126 (84.9%) | 14,330 (85.2%) | |
Arteriovenous graft | 4168 (14.6%) | 1445 (15.1%) | 2481 (14.8%) | |
Kt/Vurea | 1.53 ± 0.28 | 1.54 ± 0.27 * | 1.52 ± 0.27 * | <0.001 |
Ultrafiltration volume (L/session) | 2.20 ± 0.97 | 2.31 ± 0.93 * | 2.38 ± 0.94 *+ | <0.001 |
Hemoglobin (g/dL) | 10.7 ± 0.8 | 10.7 ± 0.8 * | 10.6 ± 0.8 *+ | <0.001 |
Serum albumin (g/dL) | 3.99 ± 0.33 | 3.98 ± 0.35 | 3.99 ± 0.34 | 0.072 |
Serum phosphorus (mg/dL) | 4.95 ± 1.33 | 4.98 ± 1.41 | 5.00 ± 1.41 * | 0.002 |
Serum calcium (mg/dL) | 8.86 ± 0.80 | 8.98 ± 0.85 * | 8.93 ± 0.84 *+ | <0.001 |
Systolic blood pressure (mmHg) | 138 ± 16 | 142 ± 15 * | 144 ± 14.6 *+ | <0.001 |
Diastolic blood pressure (mmHg) | 78 ± 10 | 78 ± 9 * | 78 ± 10 * | <0.001 |
Serum creatinine (mg/dL) | 9.3 ± 2.8 | 9.5 ± 2.7 * | 9.7 ± 2.7 *+ | <0.001 |
Use of aspirin | 10,327 (36.2%) | 4735 (49.5%) | 8544 (50.8%) | <0.001 |
Use of clopidogrel | 3825 (13.4%) | 1779 (18.6%) | 3524 (21.0%) | <0.001 |
Use of ticlopidine | 368 (1.3%) | 241 (2.5%) | 400 (2.4%) | <0.001 |
Use of cilostazol | 1579 (5.5%) | 790 (8.3%) | 1272 (7.6%) | <0.001 |
Use of stain | 7955 (27.9%) | 2900 (30.3%) | 5390 (32.1%) | <0.001 |
Univariate | Multivariate | |||
---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | |
Group | ||||
Ref: Group 1 | ||||
Group 2 | 1.33 (1.29–1.38) | <0.001 | 1.13 (1.08–1.18) | <0.001 |
Group 3 | 1.25 (1.22–1.29) | <0.001 | 1.07 (1.03–1.11) | <0.001 |
Ref: Group 3 | ||||
Group 2 | 1.06 (1.03–1.10) | 0.001 | 1.06 (1.02–1.11) | 0.009 |
Underlying cause of ESRD (ref: DM) | 0.81 (0.80–0.82) | <0.001 | 0.90 (0.89–0.91) | <0.001 |
Age (increase per 1 year) | 1.06 (1.06–1.06) | <0.001 | 1.06 (1.06–1.06) | <0.001 |
Type of vascular access (ref: arteriovenous fistula) | 1.51 (1.46–1.56) | <0.001 | 1.19 (1.14–1.24) | <0.001 |
CCI score (increase per 1 score) | 1.14 (1.13–1.14) | <0.001 | 1.07 (1.06–1.08) | <0.001 |
Sex (ref: male) | 0.87 (0.84–0.89) | <0.001 | 0.74 (0.71–0.77) | <0.001 |
Hemodialysis vintage (increase per 1 day) | 1.00 (1.00–1.00) | 0.183 | 1.00 (1.00–1.01) | <0.001 |
Ultrafiltration volume (increase per 1 kg/session) | 0.92 (0.90–0.93) | <0.001 | 1.07 (1.05–1.09) | <0.001 |
KtVurea (increase per 1 unit) | 0.91 (0.87–0.97) | 0.001 | 0.81 (0.75–0.87) | <0.001 |
Hemoglobin (increase per 1 g/dL) | 0.86 (0.85–0.88) | <0.001 | 0.90 (0.88–0.92) | <0.001 |
Serum albumin (increase per 1 g/dL) | 0.37 (0.36–0.39) | <0.001 | 0.63 (0.59–0.66) | <0.001 |
Serum creatinine (increase per 1 mg/dL) | 0.87 (0.86–0.87) | <0.001 | 0.93 (0.93–0.94) | <0.001 |
Serum phosphorus (increase per 1 mg/dL) | 0.85 (0.84–0.86) | <0.001 | 1.04 (1.03–1.06) | <0.001 |
Serum calcium (increase per 1 mg/dL) | 0.94 (0.92–0.95) | <0.001 | 1.06 (1.04–1.09) | <0.001 |
Systolic blood pressure (increase per 1 mmHg) | 1.01 (1.01–1.01) | <0.001 | 1.01 (1.00–1.01) | <0.001 |
Diastolic blood pressure (increase per 1 mmHg) | 0.98 (0.98–0.99) | <0.001 | 1.00 (1.00–1.01) | 0.018 |
Use of aspirin | 1.16 (1.13–1.19) | <0.001 | 0.96 (0.93–0.99) | 0.010 |
Use of statin | 1.10 (1.07–1.14) | <0.001 | 0.95 (0.92–0.99) | 0.010 |
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Kang, S.H.; Kim, B.Y.; Son, E.J.; Kim, G.O.; Do, J.Y. Association of Renin-Angiotensin System Blockers with Survival in Patients on Maintenance Hemodialysis. J. Clin. Med. 2023, 12, 3301. https://doi.org/10.3390/jcm12093301
Kang SH, Kim BY, Son EJ, Kim GO, Do JY. Association of Renin-Angiotensin System Blockers with Survival in Patients on Maintenance Hemodialysis. Journal of Clinical Medicine. 2023; 12(9):3301. https://doi.org/10.3390/jcm12093301
Chicago/Turabian StyleKang, Seok Hui, Bo Yeon Kim, Eun Jung Son, Gui Ok Kim, and Jun Young Do. 2023. "Association of Renin-Angiotensin System Blockers with Survival in Patients on Maintenance Hemodialysis" Journal of Clinical Medicine 12, no. 9: 3301. https://doi.org/10.3390/jcm12093301