09 Aug ACEI and ARBs Had Similar Outcomes in Study of PD Dialysis Patients
MedicalResearch.com Interview with:
Jenny Shen, MD, MS
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA
Los Angeles Biomedical Institute at Harbor-UCLA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: With cardiovascular disease being the No. 1 cause of death in end-stage kidney disease patients on peritoneal dialysis, we examined two classes of medications commonly prescribed to prevent cardiovascular events in these patients and found no significant difference in outcomes.
The two classes of medications, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB), have slightly different mechanisms and could theoretically have differing outcomes. Previous studies had suggested that ACEI may lead to a kinin-mediated increase in insulin sensitivity not seen with ARB. This could potentially lower the cardiovascular risk in patients on peritoneal dialysis because they are exposed to high glucose loads in their dialysate that may lead to insulin resistance and its associated cardiovascular risk.
Using a national database, the U.S. Renal Data System, we surveyed records for all patients enrolled in Medicare Part D who initiated maintenance peritoneal dialysis from 2007 to 2011. Of those, we found 1,892 patients using either drug class. Surveying their medical records, we found no difference in cardiovascular events or deaths between the users for each class of medication.
MedicalResearch.com: What should readers take away from your report?
Response: The study suggests that physicians can use ACEI and ARB interchangeably to prevent cardiovascular risks in their peritoneal dialysis patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Randomized trials are needed to confirm these observational results.
Jenny I. Shen, MD, is an LA BioMed lead researcher and the corresponding author of the study. Her research focuses on assessing and improving the outcomes of patients on chronic dialysis, with a particular emphasis on health disparities and medication safety and effectiveness. Her expertise is in analyzing administrative databases (big data) using advanced statistical methods that minimize the bias and confounding common in observational studies. For more information, please visit: www.labiomed.org
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Comparative effectiveness of angiotensin receptor blockers vs. angiotensin-converting enzyme inhibitors on cardiovascular outcomes in patients initiating peritoneal dialysis
Shen, J.I., Saxena, A.B., Montez-Rath, M.E. et al. J Nephrol (2016). doi:10.1007/s40620-016-0340-3
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