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. 2017 Dec;8(1):71-81.
doi: 10.1159/000479894. Epub 2017 Nov 3.

Combination Therapy with Renin-Angiotensin System Blockers and Vitamin D Receptor Activators for Predialysis Patients Is Associated with the Incidence of Cardiovascular Events after Dialysis Initiation: A Multicenter Nonrandomized Prospective Cohort Study

Daijo Inaguma  1 , Eri Ito  1 , Shigehisa Koide  1 , Kazuo Takahashi  1 , Hiroki Hayashi  1 , Midori Hasegawa  1 , Yukio Yuzawa  1
Affiliations

Combination Therapy with Renin-Angiotensin System Blockers and Vitamin D Receptor Activators for Predialysis Patients Is Associated with the Incidence of Cardiovascular Events after Dialysis Initiation: A Multicenter Nonrandomized Prospective Cohort Study

Daijo Inaguma et al. Cardiorenal Med. 2017 Dec.

Abstract

Background: Several human studies reported that the combined use of renin-angiotensin system blockers (RASBs) and vitamin D receptor activators (VDRAs) resulted in decreased urinary protein excretion. However, it is unknown whether this combination therapy influences the incidence of cardiovascular (CV) events in dialysis patients.

Methods: The study was a multicenter nonrandomized prospective cohort analysis including 1,518 patients. Patients were classified into 4 groups based on medications prescribed before dialysis initiation: those who did not receive RASBs or oral VDRAs (N group), those receiving only RASBs, those receiving only VDRAs, and those receiving a combination of RASBs and VDRAs (RD group). CV events after dialysis initiation were compared using the log-rank test. Factors contributing to the incidence of CV events were examined using multivariate Cox proportional hazard regression analysis.

Results: Significant differences were observed in the incidence of CV events and all-cause mortality between the 4 groups (p = 0.021 and p = 0.001, respectively). Cox proportional hazard analysis revealed that the incidence of CV events was significantly lower in the RD group than in the N group (hazard ratio [HR] = 0.65, 95% confidence interval [CI]: 0.50-0.86, p = 0.002). Multivariate analysis revealed that the incidence of CV events was significantly lower in the RD group than in the N group (HR = 0.66, 95% CI: 0.47-0.93, p = 0.016).

Conclusion: Combination therapy with RASBs and VDRAs in patients before dialysis initiation was associated with a reduction in CV events during maintenance dialysis.

Keywords: Cardiovascular events; Chronic kidney disease; Dialysis; Renin-angiotensin system blocker; Vitamin D; Vitamin D receptor activator.

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Figures

Fig. 1
Fig. 1
Comparison of cardiovascular events between the 4 groups. Significant differences were observed between the 4 groups' cumulative event-free rates (p = 0.021). N group, no use of RASBs (ACEIs or ARBs) or VDRAs; R group, use of RASBs only; D group, use of VDRAs; RD group, use of both RASBs and VDRAs; RASB, renin-angiotensin system blocker; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; VDRA, vitamin D receptor activator.
Fig. 2
Fig. 2
Comparison of cardiovascular events between the R and RD groups after propensity score matching. Significant differences were observed between the 2 groups' cumulative event-free rates (p = 0.032). R group, use of RASBs only; RD group, use of both RASBs and VDRAs; RASB, renin-angiotensin system blocker; VDRA, vitamin D receptor activator.
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