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ACE inhibitors and survival of hemodialysis patients

Shai Efrati1, Ronit Zaidenstein, Victor Dishy

  • 1Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel. efratishai@barak-online.net

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|October 31, 2002
PubMed

Insights

Angiotensin-converting enzyme (ACE) inhibitors significantly reduced mortality in patients undergoing long-term hemodialysis. This effect was particularly pronounced in patients 65 years or younger, suggesting benefits beyond blood pressure control.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Cardiovascular disease is a primary cause of mortality in end-stage renal disease (ESRD) patients.
  • Hypertension exacerbates cardiovascular risks in ESRD.
  • Angiotensin-converting enzyme (ACE) inhibitors are established treatments for hypertension in ESRD, potentially improving outcomes.

Purpose of the Study:

  • To investigate the impact of ACE inhibitors on mortality rates in patients undergoing long-term hemodialysis.
  • To determine if ACE inhibitors offer survival benefits independent of their antihypertensive effects.

Main Methods:

  • Retrospective review of clinical data from hemodialysis patients between 1994 and 2000.
  • Patients were categorized into two groups: those treated with ACE inhibitors and those not treated.

Main Results:

  • Mortality was significantly reduced by 52% in the ACE inhibitor-treated group compared to the untreated group (RR, 0.482; P < 0.0019).
  • In patients 65 years or younger, ACE inhibitors led to a 79% absolute risk reduction in mortality (RR, 0.211; P < 0.0006).
  • No significant difference in blood pressure reduction was observed between the groups.

Conclusions:

  • ACE inhibitors may substantially decrease mortality in chronic hemodialysis patients.
  • The mortality benefit appears independent of the antihypertensive effect of ACE inhibitors.
  • Further research is warranted, but findings suggest ACE inhibitors are beneficial, especially for younger hemodialysis patients (≤65 years).
Abstract

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