Kidney Week

Abstract: TH-PO423

Use of Calcium Channel Blockers Before Dialysis until Dialysis Initiation Is Associated with All-Cause Mortality During Maintenance Dialysis

Session Information

• Hypertension and CVD: Epidemiology, Risk Factors, Prevention
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

• Inaguma, Daijo, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

Daijo Inaguma,

• Yuzawa, Yukio, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

Yukio Yuzawa,

• Hasegawa, Midori, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

Midori Hasegawa,

• Takahashi, Kazuo, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

Kazuo Takahashi,

Background

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are reno-protective renin-angiotensin system blockade agents (RASBs) that are recommended for patients with chronic kidney disease (CKD), especially for diabetic nephropathy. However, a meta-analysis of CKD patients including those on dialysis demonstrated no significant difference in mortality between those on RASBs or calcium channel blockers (CCBs). Therefore, we examined whether the use of CCBs was associated with all-cause mortality and cardiovascular (CV) events in patients with incident dialysis.

Methods

The subjects were patients in 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis between October 2011 and September 2013. We enrolled 1,520 subjects in the study. Baseline was defined as the time at which dialysis was initiated. Survival prognosis and incidence of CV events as of September 30, 2016, were determined from medical records. We classified patients into two groups according to the use of CCBs at the time of dialysis initiation: those who received CCBs (CCB group; n = 1,199) and those did not receive CCBs (non-CCB group; n = 321). Study outcomes included mortality and the incidence of CV events in the two groups. Factors contributing to all-cause mortality were examined using multivariate Cox proportional hazards regression analysis. In addition, we compared all-cause mortality stratified by use of RASBs.

Results

A log-rank test showed significant differences in all-cause mortality and the incidence of CV events between the two groups (p = 0.001 and p = 0.003, respectively). Multivariate stepwise Cox proportional hazards analysis revealed that all-cause mortality and the incidence of CV events were significantly lower in the CCB group than in the non-CCB group (hazard ratio [HR] = 0.62, 95% confidence interval [CI]: 0.46 – 0.85, p = 0.003 and HR = 0.74, 95% CI = 0.56 – 0.98, p = 0.037) (Table). All-cause mortality rates were significantly lower in the CCB group than in the non-CCB group among patients who did not receive RASBs (HR = 0.70, 95% CI: 0.52 – 0.95, p = 0.021).

Conclusion

The use of CCBs in patients before dialysis initiation was associated with reduction in all-cause mortality and CV events during maintenance dialysis.