Renin-angiotensin system blockade in heart failure patients on long-term haemodialysis in Taiwan

• Published in: European journal of heart failure Vol. 15; no. 10; pp. 1194 - 1202
• Main Authors: Tang, Chao-Hsiun, Chen, Tso-Hsiao, Wang, Chia-Chen, Hong, Chuang-Ye, Huang, Kuan-Chih, Sue, Yuh-Mou
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2013
• Subjects: ACE inhibitor; Adult; Aged; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; ARB; Female; haemodialysis; heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - mortality; Hospitalization; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Middle Aged; mortality; Propensity Score; Proportional Hazards Models; Renal Dialysis; Renin-Angiotensin System; Taiwan; Treatment Outcome; Taiwan; Heart failure; Renin–angiotensin system; ARB; Haemodialysis; Mortality; ACE inhibitor
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hft082

Aims Heart failure is among the most frequent complications of patients on long‐term haemodialysis. The benefits of renin–angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined. Methods and results We conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new‐onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD‐9‐CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e. an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non‐RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3‐year all‐cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time‐dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0%) occurred during 5272 person‐years of follow‐up compared with 734 deaths (42.0%) among non‐RASB users during 2683 person‐years of follow‐up. Three‐year mortality rates were 45.4% and 49.1% for patients receiving and those not receiving an RASB, respectively (log‐rank test, P < 0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all‐cause [hazard ratio (HR) 0.8; 95% confidence interval (CI) 0.72–0.89; P < 0.001] and cardiovascular mortality (HR 0.76; 95% CI 0.64–0.90; P < 0.01). Conclusions RASB therapy reduced all‐cause and cardiovascular mortality in heart failure patients on long‐term haemodialysis.