Relationship Between Patterns in Antihypertensive Drugs Medication and Mortality in Incident Dialysis Patients: A Multicenter Prospective Cohort Study

Maya Fujii, Daijo Inaguma, Shigehisa Koide, Eri Ito, Kazuo Takahashi, Hiroki Hayashi, Naotake Tsuboi, Midori Hasegawa, Yukio Yuzawa

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Hypertension is common in patients with chronic kidney disease. Whether blood pressure management before dialysis initiation influences prognosis during maintenance dialysis remains unclear. Hence, we surveyed the status of antihypertensive drug use in incident dialysis patients. Moreover, we examined the association between antihypertensive drug use patterns at the time of dialysis initiation and mortality. We used a database derived from the multicenter prospective Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis, which included 1520 incident dialysis patients in Aichi prefecture, Japan. The baseline in the present study was set as the time of dialysis initiation. We examined antihypertensive drug prescription patterns at baseline, as well as the association between use of antihypertensive drugs and mortality after dialysis initiation. Among all participants, 1440 were taking at least one antihypertensive drug. The rate of calcium channel blocker (CCB) use was highest, accounting for 74.3%. CCB use was significantly associated with lower all-cause and cardiovascular-related mortality (hazard ratio [HR]: 0.62 and 0.57, 95% confidence interval [CI]: 0.46–0.85 and [0.35–0.91], respectively). Compared with no use of either drug, combination therapy with a renin angiotensin system blocker (RASB) and CCB was significantly associated with lower mortality (HR: 0.51, 95% CI: 0.34–0.76). The present study demonstrated that antihypertensive drugs were used in 95% of incident dialysis patients. In addition, use of a CCB and combination therapy with a CCB and RASB at the time of dialysis initiation was associated with lower mortality during maintenance dialysis.

Original languageEnglish
Pages (from-to)353-361
Number of pages9
JournalTherapeutic Apheresis and Dialysis
Volume23
Issue number4
DOIs
Publication statusPublished - 01-01-2019

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Antihypertensive Agents
Dialysis
Cohort Studies
Prospective Studies
Mortality
Calcium Channel Blockers
Renin-Angiotensin System
Maintenance
Confidence Intervals
Drug Prescriptions
Combination Drug Therapy
Chronic Renal Insufficiency
Japan
Databases
Blood Pressure
Hypertension

All Science Journal Classification (ASJC) codes

  • Hematology
  • Nephrology

Cite this

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title = "Relationship Between Patterns in Antihypertensive Drugs Medication and Mortality in Incident Dialysis Patients: A Multicenter Prospective Cohort Study",
abstract = "Hypertension is common in patients with chronic kidney disease. Whether blood pressure management before dialysis initiation influences prognosis during maintenance dialysis remains unclear. Hence, we surveyed the status of antihypertensive drug use in incident dialysis patients. Moreover, we examined the association between antihypertensive drug use patterns at the time of dialysis initiation and mortality. We used a database derived from the multicenter prospective Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis, which included 1520 incident dialysis patients in Aichi prefecture, Japan. The baseline in the present study was set as the time of dialysis initiation. We examined antihypertensive drug prescription patterns at baseline, as well as the association between use of antihypertensive drugs and mortality after dialysis initiation. Among all participants, 1440 were taking at least one antihypertensive drug. The rate of calcium channel blocker (CCB) use was highest, accounting for 74.3{\%}. CCB use was significantly associated with lower all-cause and cardiovascular-related mortality (hazard ratio [HR]: 0.62 and 0.57, 95{\%} confidence interval [CI]: 0.46–0.85 and [0.35–0.91], respectively). Compared with no use of either drug, combination therapy with a renin angiotensin system blocker (RASB) and CCB was significantly associated with lower mortality (HR: 0.51, 95{\%} CI: 0.34–0.76). The present study demonstrated that antihypertensive drugs were used in 95{\%} of incident dialysis patients. In addition, use of a CCB and combination therapy with a CCB and RASB at the time of dialysis initiation was associated with lower mortality during maintenance dialysis.",
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Relationship Between Patterns in Antihypertensive Drugs Medication and Mortality in Incident Dialysis Patients : A Multicenter Prospective Cohort Study. / Fujii, Maya; Inaguma, Daijo; Koide, Shigehisa; Ito, Eri; Takahashi, Kazuo; Hayashi, Hiroki; Tsuboi, Naotake; Hasegawa, Midori; Yuzawa, Yukio.

In: Therapeutic Apheresis and Dialysis, Vol. 23, No. 4, 01.01.2019, p. 353-361.

Research output: Contribution to journalArticle

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AU - Fujii, Maya

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AU - Ito, Eri

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AU - Hayashi, Hiroki

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AU - Hasegawa, Midori

AU - Yuzawa, Yukio

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